Shoulder and Elbow Surgery
Arthroscopic autologous scapular spine bone graft transplant for shoulder recurrent instability
Xiang Ming, Yang Jinsong, Chen Hang, Hu Xiaochuan, Zhang Qing, Li Yiping, Deng Mingyue, Gong Chaomin
Published 2020-01-01
Cite as Chin J Orthop, 2020,40(1): 23-31. DOI: 10.3760/cma.j.issn.0253-2352.2020.01.004
Abstract
ObjectiveTo investigate the clinical outcomes and radiological results of arthroscopic autologous scapular spine bone graft transplant to treat shoulder recurrent instability.
MethodsData of 27 patients diagnosed as shoulder recurrent instability with the bone defect of 10%-15% from July 2016 to August 2018 who were treated by arthroscopic autologous scapular spine bone graft transplant were retrospectively analyzed. There were 20 males and 7 females with an average age of 30.8 years old (range, 19-50). The bone loss of the glenoid was 10%-15%. The time between the first dislocation and the surgery was 24.1±15.8 months. The patients were treated with arthroscopic autologous scapular spine bone graft transplant. Postoperatively the affected shoulder was immobilized by the abduction brace for 6 weeks, after that the passive motion was applied. Strengthening exercise began at 10-12 weeks and sports was allowed after 6 months. Constant-Murley score and the Disabilities of Arm, Shoulder and Hand (DASH) score were used to evaluate the shoulder function, and visual analogue score (VAS) score was used to evaluate the degree of pain. Computed tomography scans were obtained one week post-operation and at the latest follow-up, from which the length, width, height and volume of the bone graft were measured and the absorption rate of the bone graft was calculated. The subjective satisfaction degree of patients at the latest follow-up was also recorded.
ResultsAll 27 patients were followed up for 19.8 months (range, 13-39 months). No infection or neurovascular injury was identified. At the latest follow-up, the Constant-Murley score was 85.15±5.62 (range, 76-94), the DASH score 13.39±5.51 (range, 3.19-21.95) and the VAS score 1.29±0.45 (range, 1-2), thus all of those were improved significantly compared to those of pre-operation. At the latest follow-up, the anterior flexion was 153°±24°, lateral rotation by side 38°±21°, internal rotation 70°±21°, and abduction was 139°±18°. At the latest follow-up, the absorption rate of the bone graft was 46.1%±20.6% (range, 24.0%-71.7%). Among all the 27 patients, 19 patients considered the outcome as very good, and 6 patients considered as good, 2 patients fair.
ConclusionArthroscopic autologous scapular spine bone graft transplant could successfully treat shoulder recurrent instability with glenoid bone loss at 10%-15%. This technique could achieve satisfactory clinical results, improve glenohumeral stability, decrease the re-dislocation rate.
Key words:
Shoulder joint; Shoulder dislocation; Arthroscopy; Transplantation, autologous
Contributor Information
Xiang Ming
Department of Upper Limb, Sichuan Provincial Orthopaedic Hospital, Chengdu 610041, China;
Yang Jinsong
Chen Hang
Hu Xiaochuan
Zhang Qing
Li Yiping
Deng Mingyue
Gong Chaomin