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Bipolar bone loss in patients with traumatic anterior shoulder instability: effectiveness of glenoid bone graft augmentation alone
ESSKA Academy. Iizawa N. Nov 8, 2019; 284425; epESMA-10 Topic: Sports Related Injuries
Dr. Norishige Iizawa
Dr. Norishige Iizawa
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Bipolar bone loss in patients with traumatic anterior shoulder instability: effectiveness of glenoid bone graft augmentation alone

ePoster - epESMA-10

Topic: Sports Injury and Return to Competition Criteria

Iizawa N., Yoneda M., Nakajima S., Iwashita S., Takai S.
Nippon Medical School, Tokyo, Japan

Introduction: The combination of glenoid bone loss and Hill-Sachs lesion (HSL) in traumatic anterior shoulder instability has been termed bipolar bone loss (BBL) and causes an off-track status, which is considered a risk factor for postoperative re-dislocation. When performing arthroscopic Bankart repair for BBL, treatment for glenoid bone loss and/or HSL is generally performed. There has been no study on whether residual HSL affects the postoperative re-dislocation when the bone augmentation is performed only for the glenoid bone loss.
Objectives: The purpose of this study was to investigate whether the severity of untreated HSL affects postoperative results when glenoid bone augmentation alone is performed.
Methods: Of the 652 patients of traumatic anterior shoulder instability subjected to arthroscopic Bankart repair available for retrospective study, 59 met this study's inclusion criteria. The inclusion criteria were 1) no treatment for HSL even for BBL, 2) arthroscopic bone graft was used for glenoid bone loss only, 3) graft union was confirmed, and 4) more than 2 years follow-up after surgery. The average age of subjects was 26.3 years, and the average follow-up period was 28.2 months in 46 males and 13 females. The average glenoid bone loss was 20.1% (10-35%), and the arthroscopic severity of HSL in accordance with Calandra et al. was grade I (n = 9), II (n = 37), and III (n = 13). The postoperative Rowe scores and re-dislocation rates were investigated, and the on-track or off-track status before and after surgery was calculated by the method of Di Giacomo et al. Mann-Whitney U-test and Pearson´s chi-square test were used for statistical analysis.
Results: Overall, the average Rowe score for all cases was 92.4 ±13.3, and re-dislocation occurred in only 2 cases (3.4%). For grade I, all cases were on-track before and after surgery. For grade II, 2 cases were off-track before, but on-track after surgery. In grade III, 11 cases were off-track before surgery, but all of those cases were on-track after surgery. Rowe scores were 90.6 ±18.9, 93.4 ±7.4, and 90.8 ±6.0 for grades I, II and III, respectively, and re-dislocation occurred only in 1 case in Grade I and 1 case in Grade III. There were no significant differences among the three groups in either Rowe score or re-dislocation rate.
Conclusions: Bone graft augmentation to the glenoid alone was effective for traumatic anterior shoulder instability with BBL, regardless of the severity of untreated HSL.
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