PMID- 33847693 OWN - NLM STAT- MEDLINE DCOM- 20211015 LR - 20230814 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 479 IP - 9 DP - 2021 Sep 1 TI - Posterior Open-wedge Osteotomy and Glenoid Concavity Reconstruction Using an Implant-free, J-shaped Iliac Crest Bone Graft in Atraumatic Posterior Instability with Pathologic Glenoid Retroversion and Dysplasia: A Preliminary Report. PG - 1995-2005 LID - 10.1097/CORR.0000000000001757 [doi] AB - BACKGROUND: Atraumatic posterior shoulder instability in patients with pathologic glenoid retroversion and dysplasia is an unsolved problem in shoulder surgery. QUESTIONS/PURPOSES: In a preliminary study of a small group of patients with atraumatic posterior shoulder instability associated with glenoid retroversion >/= 15 degrees and glenoid dysplasia who underwent posterior open-wedge osteotomy and glenoid concavity reconstruction using an implant-free, J-shaped iliac crest bone graft, we asked: (1) What proportion of the patients had persistent apprehension? (2) What were the improvements in patient-reported shoulder scores? (3) What were the radiographic findings at short-term follow-up? METHODS: Between 2016 and 2018, we treated seven patients for atraumatic posterior shoulder instability. We performed this intervention when posterior shoulder instability symptoms were unresponsive to physiotherapy for at least 6 months and when it was associated with glenoid retroversion >/= 15 degrees and dysplasia of the posteroinferior glenoid. All seven patients had a follow-up examination at a minimum of 2 years. The median (range) age at surgery was 27 years (16 to 45) and the median follow-up was 2.3 years (2 to 3). Apprehension was assessed by a positive posterior apprehension and/or posterior jerk test. Patient-reported shoulder scores were obtained and included the subjective shoulder value, obtained by chart review (and scored with 100% representing a normal shoulder; minimum clinically important difference [MCID] 12%), and the Constant pain scale score (with 15 points representing no pain; MCID 1.5 points). Radiographic measurements included glenohumeral arthropathy and posterior humeral head subluxation, bone graft union, correction of glenoid retroversion and glenoid concavity depth, as well as augmentation of glenoid surface area. All endpoints were assessed by individuals not involved in patient care. RESULTS: In four of seven patients, posterior apprehension was positive, but none reported resubluxation. The preoperative subjective shoulder value (median [range] 40% [30% to 80%]) and Constant pain scale score (median 7 points [3 to 13]) were improved at latest follow-up (median subjective shoulder value 90% [70% to 100%]; p = 0.02; median Constant pain scale score 15 points [10 to 15]; p = 0.03). Posterior glenoid cartilage erosion was present in four patients (all four had Walch Type B1 glenoids) preoperatively and showed no progression until the final follow-up examination. The median (range) humeral head subluxation index decreased from 69% (54% to 85%) preoperatively to 55% (46% to 67%) postoperatively (p = 0.02), and in two of four patients with preoperative humeral head subluxation (> 65% subluxation), it was reversed to a centered humeral head. CT images showed union in all implant-free, J-shaped iliac crest bone grafts. The median preoperative retroversion was corrected from 16 degrees (15 degrees to 25 degrees ) to 0 degrees postoperatively (-5 degrees to 6 degrees ; p = 0.02), the median glenoid concavity depth was reconstructed from 0.3 mm (-0.7 to 1.6) preoperatively to 1.2 mm (1.1 to 3.1) postoperatively (p = 0.02), and the median preoperative glenoid surface area was increased by 20% (p = 0.02). No intraoperative or postoperative complications were recorded, and no reoperation was performed or is planned. CONCLUSION: In this small, retrospective series of patients treated by experienced shoulder surgeons, a posterior J-bone graft procedure was able to reconstruct posterior glenoid morphology, correct glenoid retroversion, and improve posterior shoulder instability associated with pathologic glenoid retroversion and dysplasia, although four of seven patients had persistent posterior apprehension. Although no patients in this small series experienced complications, the size and complexity of this procedure make it likely that as more patients have it, some will develop complications; future studies will need to characterize the frequency and severity of those complications, and we recommend that this procedure be done only by experienced shoulder surgeons. The early results in these seven patients justify further study of this procedure for the proposed indication, but longer term follow-up is necessary to continue to assess whether it is advantageous to combine the reconstruction of posterior glenoid concavity with correction of pathological glenoid retroversion and increasing glenoid surface compared with traditional surgical techniques such as the posterior opening wedge osteotomy or simple posterior bone block procedures. LEVEL OF EVIDENCE: Level IV, therapeutic study. CI - Copyright (c) 2021 by the Association of Bone and Joint Surgeons. FAU - Ernstbrunner, Lukas AU - Ernstbrunner L AD - Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland. FAU - Haller, Thomas AU - Haller T FAU - Waltenspul, Manuel AU - Waltenspul M FAU - Wieser, Karl AU - Wieser K FAU - Gerber, Christian AU - Gerber C LA - eng PT - Journal Article PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 SB - IM CIN - Clin Orthop Relat Res. 2021 Sep 1;479(9):2006-2008. PMID: 33950881 MH - Adolescent MH - Adult MH - Bone Diseases, Developmental/*surgery MH - Bone Transplantation/*methods MH - Humans MH - Ilium/*transplantation MH - Joint Instability/*surgery MH - Middle Aged MH - Osteotomy/*methods MH - Patient Reported Outcome Measures MH - Retrospective Studies MH - Shoulder Joint/*surgery MH - Young Adult PMC - PMC8373563 COIS- Each author certifies that neither he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2021/04/14 06:00 MHDA- 2021/10/16 06:00 PMCR- 2022/09/01 CRDT- 2021/04/13 12:12 PHST- 2020/12/29 00:00 [received] PHST- 2021/03/09 00:00 [accepted] PHST- 2021/04/14 06:00 [pubmed] PHST- 2021/10/16 06:00 [medline] PHST- 2021/04/13 12:12 [entrez] PHST- 2022/09/01 00:00 [pmc-release] AID - 00003086-202109000-00022 [pii] AID - CORR-D-20-02171 [pii] AID - 10.1097/CORR.0000000000001757 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2021 Sep 1;479(9):1995-2005. doi: 10.1097/CORR.0000000000001757.