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.
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).
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.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Hovelius L, Augustini BG, Fredin H et al (1996) Primary anterior dislocation of the shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 78:1677–1684. https://doi.org/10.2106/00004623-199611000-00006
Edwards TB, Boulahia A, Walch G (2003) Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy 19:732–739. https://doi.org/10.1016/s0749-8063(03)00684-4
Itoi E, Lee SB, Berglund LJ et al (2000) The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am 82:35–46. https://doi.org/10.2106/00004623-200001000-00005
Rowe CR, Patel D, Southmayd WW (1978) The Bankart procedure: a long-term end-result study. JBJS 60:1–16
Sugaya H, Moriishi J, Dohi M et al (2003) Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 85:878–884. https://doi.org/10.2106/00004623-200305000-00016
Chen AL, Hunt SA, Hawkins RJ, Zuckerman JD (2005) Management of bone loss associated with recurrent anterior glenohumeral instability. Am J Sports Med 33:912–925. https://doi.org/10.1177/0363546505277074
Gerber C, Lambert SM (1996) Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder. J Bone Joint Surg Am 78:376–382. https://doi.org/10.2106/00004623-199603000-00008
Rabinowitz J, Friedman R, Eichinger JK (2017) Management of glenoid bone loss with anterior shoulder instability: indications and outcomes. Curr Rev Musculoskelet Med 10:452–462. https://doi.org/10.1007/s12178-017-9439-y
Zhao J, Huangfu X, Yang X et al (2014) Arthroscopic glenoid bone grafting with nonrigid fixation for anterior shoulder instability: 52 patients with 2- to 5-year follow-up. Am J Sports Med 42:831–839. https://doi.org/10.1177/0363546513519227
Auffarth A, Schauer J, Matis N et al (2008) The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med 36:638–647. https://doi.org/10.1177/0363546507309672
Warner JJP, Gill TJ, O’hollerhan JD et al (2006) Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft. Am J Sports Med 34:205–212. https://doi.org/10.1177/0363546505281798
Kraus N, Amphansap T, Gerhardt C, Scheibel M (2014) Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elbow Surg 23:1700–1708. https://doi.org/10.1016/j.jse.2014.03.004
Balg F, Boileau P (2007) The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 89:1470–1477. https://doi.org/10.1302/0301-620X.89B11.18962
Blonna D, Bellato E, Caranzano F et al (2016) Arthroscopic bankart repair versus open Bristow-Latarjet for shoulder instability: a matched-pair multicenter study focused on return to sport. Am J Sports Med 44:3198–3205. https://doi.org/10.1177/0363546516658037
Zimmermann SM, Scheyerer MJ, Farshad M et al (2016) Long-term restoration of anterior shoulder stability: a retrospective analysis of arthroscopic bankart repair versus open latarjet procedure. J Bone Joint Surg Am 98:1954–1961. https://doi.org/10.2106/JBJS.15.01398
Moroder P, Blocher M, Auffarth A et al (2014) Clinical and computed tomography-radiologic outcome after bony glenoid augmentation in recurrent anterior shoulder instability without significant glenoid bone loss. J Shoulder Elbow Surg 23:420–426. https://doi.org/10.1016/j.jse.2013.07.048
Di Giacomo G, Costantini A, de Gasperis N et al (2011) Coracoid graft osteolysis after the Latarjet procedure for anteroinferior shoulder instability: a computed tomography scan study of twenty-six patients. J Shoulder Elbow Surg 20:989–995. https://doi.org/10.1016/j.jse.2010.11.016
Scheibel M, Nikulka C, Dick A et al (2008) Autogenous bone grafting for chronic anteroinferior glenoid defects via a complete subscapularis tenotomy approach. Arch Orthop Trauma Surg 128:1317–1325. https://doi.org/10.1007/s00402-007-0560-z
Mascarenhas R, Raleigh E, McRae S et al (2014) Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: surgical technique and results. Int J Shoulder Surg 8:127. https://doi.org/10.4103/0973-6042.145269
DiPaola MJ, Jazrawi LM, Rokito AS et al (2010) Management of humeral and glenoid bone loss–associated with glenohumeral instability. Bull NYU Hosp Jt Dis 68:245–250
Kalogrianitis S, Tsouparopoulos V (2016) Arthroscopic iliac crest bone block for reconstruction of the glenoid: a fixation technique using an adjustable-length loop cortical suspensory fixation device. Arthrosc Tech 5:e1197–e1202. https://doi.org/10.1016/j.eats.2016.07.007
Malik SS, Knight R, Ahmed U, Prem H (2018) Role of a tendon transfer as a dynamic checkrein reducing recurrence of equinus following distal tibial dorsiflexion osteotomy. J Pediatr Orthop B 27:419–424. https://doi.org/10.1097/BPB.0000000000000500
Malahias M-A, Fandridis E, Chytas D et al (2019) Arthroscopic versus open Latarjet: a step-by-step comprehensive and systematic review. Eur J Orthop Surg Traumatol 29:957–966. https://doi.org/10.1007/s00590-019-02398-3
We would like to thank Mr Muaaz Tahir for his help with statistics.
No funding was received by any of the authors for this study.
Conflict of interest
The authors declare that they have no competing interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
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
- Recurrent shoulder instability
- Glenoid deficiency
- Glenoid reconstruction
- Bone block
- Tricortical iliac crest graft