Background:Glenoid reconstruction with a bone block for anterior glenoid bone loss (GBL) has shown excellent outcomes. However, fixation techniques that require metal implants are associated with metal-related complications and bone graft resorption.Hypothesis:Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft (ICBG) and metal-free suture tape cerclage fixation can safely and effectively restore the glenoid surface area in patients with recurrent anterior shoulder instability and anterior GBL.Study Design:Case series; Level of evidence, 4.Methods:Adult patients (≥18 years) of both sexes with recurrent anterior shoulder instability and anterior GBL ≥15% were enrolled. These patients underwent arthroscopic glenoid reconstruction with ICBGs and metal-free suture tape cerclage fixation. The effectiveness and clinical outcomes with this technique were evaluated at 24 months using functional scores. Resorption of the graft articular surface was assessed by computed tomography, with the graft surface divided into 6 square areas aligned in 2 columns. Descriptive analysis was conducted.Results:A total of 23 consecutive patients met inclusion criteria (22 male, 1 female; mean age, 30.5 ± 7.9 years). The mean preoperative GBL was 19.7% ± 3.4%, and there were 15 allograft and 8 autograft ICBGs. All patients exhibited graft union at 3 months. The median follow-up was 38.5 months (interquartile range, 24-45 months). The Western Ontario Shoulder Instability Index, Rowe, Constant-Murley, and Subjective Shoulder Value scores improved from preoperatively (35.1%, 24.8, 83.1, and 30.9, respectively) to postoperatively (84.7%, 91.1, 96.0, and 90.9, respectively) ( P < .001). No differences in clinical scores were observed between the graft types. One surgical wound infection was reported, and 2 patients (8.7% [95% CI, 2.4%-26.8%]) required a reoperation. The mean overall glenoid surface area increased from 80.3% ± 3.5% to 117.0% ± 8.3% immediately after surgery before subsequently reducing to 98.7% ± 6.2% and 95.0% ± 5.7% at 12 and 24 months, respectively ( P < .001). The mean graft resorption rate was 18.1% ± 7.9% in the inner column and 80.3% ± 22.4% in the outer column. Additionally, 3 patients treated with an allograft (20.0% [95% CI, 7.1%-45.2%]), including the 2 with clinical failures, exhibited complete graft resorption at the last follow-up.Conclusion:Arthroscopic glenoid reconstruction using an ICBG and metal-free suture tape cerclage fixation was safe and effective, yielding excellent clinical outcomes. Resorption of the graft articular surface predominantly affected the nonloaded areas beyond the best-fit circle perimeter.

中文翻译：

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无金属骨块缝合带环扎固定复发性前肩不稳定后的临床结果和移植物吸收：计算机断层扫描分析

背景：用骨块进行关节盂重建治疗前关节盂骨丢失（GBL）已显示出良好的效果。然而，需要金属植入物的固定技术与金属相关的并发症和骨移植吸收有关。假设：采用三皮质髂嵴骨移植（ICBG）和无金属缝线环扎固定的关节镜下关节盂重建可以安全有效地恢复关节盂复发性肩关节前不稳定和前 GBL 患者的表面积。研究设计：病例系列；证据级别4。方法：纳入患有复发性肩关节前不稳定且前GBL ≥15% 的男女成年患者（≥18 岁）。这些患者接受了关节镜下关节盂重建，采用 ICBG 和无金属缝合带环扎固定。使用功能评分在 24 个月时评估该技术的有效性和临床结果。通过计算机断层扫描评估移植物关节表面的吸收，将移植物表面分为 2 列对齐的 6 个正方形区域。进行描述性分析。结果：共有23名连续患者符合纳入标准（22名男性，1名女性；平均年龄，30.5±7.9岁）。术前平均GBL为19.7%±3.4%，同种异体移植ICBG 15例，自体移植ICBG 8例。所有患者均在 3 个月时表现出移植物愈合。中位随访时间为 38.5 个月（四分位数范围，24-45 个月）。西安大略肩部不稳定性指数、Rowe、Constant-Murley 和主观肩部值评分从术前（分别为 35.1%、24.8、83.1 和 30.9）改善到术后（分别为 84.7%、91.1、96.0 和 90.9）（ P < .001)。不同移植类型之间的临床评分没有差异。报告有 1 例手术伤口感染，2 例患者 (8.7% [95% CI, 2.4%-26.8%]) 需要再次手术。术后平均关节盂总表面积从 80.3% ± 3.5% 增加至 117.0% ± 8.3%，随后在 12 个月和 24 个月时分别降至 98.7% ± 6.2% 和 95.0% ± 5.7% ( P < .001) 。内柱平均移植物吸收率为 18.1% ± 7.9%，外柱平均移植物吸收率为 80.3% ± 22.4%。此外，3 名接受同种异体移植治疗的患者（20.0% [95% CI，7.1%-45.2%]），包括 2 名临床失败的患者，在最后一次随访时表现出移植物完全吸收。结论：使用 ICBG 进行关节镜下关节盂重建无金属缝线环扎固定安全有效，临床效果良好。移植物关节面的吸收主要影响超出最佳拟合圆周边的无负载区域。