Is there a difference in outcome of arthroscopic iliac crest autograft and allograft in recurrent anterior shoulder instability?

Abstract

Objective

The aim of this study was to compare outcomes of arthroscopic tricortical iliac crest autograft and allograft bone blocks for recurrent traumatic anterior shoulder instability in terms of bone resorption, union and recurrent instability and assess which one is a better graft choice.

Patients and methods

Twenty-two consecutive patients treated for recurrent traumatic anterior shoulder instability that required reconstruction with bone block were included in the study. Surgical reconstruction was carried out arthroscopically with contoured tricortical iliac crest autograft or allograft. At follow-up, patients were assessed for Oxford Shoulder Instability Score (OSIS), recurrent dislocation, apprehension testing, complications, and 3-dimensional computed tomography (CT) for resorption and union rate at a mean of 10.89 months.

Results

There were 10 patients in the allograft group with a median age of 27.7 years and a mean follow-up of 26.6 months. In the autograft group, there were 12 patients with a median age of 29 years and a mean follow-up of 28.7 months. The OSIS increased in both groups but was significantly higher in the autograft group (54.1 vs 48.2, p = 0.02). There were 2 failures in each group but no hardware complications. Allograft had higher resorption rate in comparison (75% in allograft vs 40% in autograft) and higher non-union rate (62.5% in allograft vs 16.5% in autograft).

Conclusion

This study demonstrated that both tricortical iliac crest autograft and allograft can improve shoulder instability symptoms. However, the results suggest that autograft may lead to significantly improved instability score, higher union rate and less bone resorption.

Level of evidence

IV, retrospective study.

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Acknowledgements

We would like to thank Mr Muaaz Tahir for his help with statistics.

Funding

No funding was received by any of the authors for this study.

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Authors

Contributions

SK performed surgical procedures and co-ordinated study. SC performed radiological analysis. SSM & SE participated in collecting the data. SSM & RWJ wrote the article.

Corresponding author

Correspondence to Shahbaz S. Malik.

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The authors declare that they have no competing interest.

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Malik, S.S., Elashry, S., Jordan, R.W. et al. Is there a difference in outcome of arthroscopic iliac crest autograft and allograft in recurrent anterior shoulder instability?. Eur J Orthop Surg Traumatol (2020). https://doi.org/10.1007/s00590-020-02722-2

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Keywords

  • Recurrent shoulder instability
  • Glenoid deficiency
  • Glenoid reconstruction
  • Bone block
  • Tricortical iliac crest graft