Summary

The evaluation of iliac crest bone grafting for the treatment of recurrent shoulder instability.

Abstract

Purpose

The primary objective of this study was to establish a safety profile for an all-arthroscopic anatomic glenoid reconstruction using iliac crest autograft augmentation for the treatment of shoulder instability with glenoid bone loss. Secondary outcomes include short-term clinical and radiological outcomes.

Methods

This study involved a retrospective analysis of 13 consecutive patients (male=7, female=6) treated for shoulder instability with >25% glenoid bone loss using autologous iliac crest bone graft between 2014 and 2018. Of 13 patients, 10 had post-operative CTs and eight had pre and post-operative WOSI scores. The safety profile was established by examining intra-operative and post-operative complications such as neurovascular injuries, infections, subluxations, and dislocations. Secondary outcomes assessed pre-operative and post-operative Western Ontario Shoulder Instability (WOSI) index, radiographs, CT scans, and clinical findings.

Results

There were no intraoperative complications, neurovascular injuries, adverse events, or major bleeding. There were no subluxations or positive apprehension tests on clinical examination post-operatively. Average WOSI score at most recent follow-up significantly improved from pre-op by 35.8%±19.1 (p-value = 0.00579). Average follow-up for CT scan was 11 (SD± 14.6) months, where all patients showed healing of bone graft to native glenoid. Mild graft resorption was seen according to physiologic remodeling in some patients.

Conclusion

Arthroscopic treatment of shoulder instability via autologous iliac crest bone graft is shown to be a safe procedure that results in favorable short-term clinical and radiological outcomes. Further investigations must be done to evaluate the longevity of these health outcomes.