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Arthroskopische J-Span-Implantation bei knöchernem Glenoiddefekt

Klinische und radiologische Einjahresergebnisse

All-arthroscopic J-bone grafting in chronic anterior shoulder instability with glenoid bone loss

Clinical and radiographic 1-year outcome

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Zusammenfassung

Hintergrund

Im Falle eines knöchernen Glenoiddefekts ist bei rezidivierender Instabilität des Schultergelenks die bloße Weichteilrekonstruktion (Bankart-Operation) nicht ausreichend. Unterschiedliche offene Techniken zur knöchernen Augmentation zeigen gute Langzeitresultate, arthoskopische Verfahren spiegeln diese in Kurzzeituntersuchungen wider. In der vorliegenden Arbeit werden die klinischen und radiologischen Ergebnisse 3 und 12 Monate nach arthroskopischer J-Span-Plastik vorgestellt.

Material und Methoden

Zehn konsekutiv aufgenommene Patienten (9 männlich, 1 weiblich, durchschnittliches Alter 29,1 Jahre) mit traumatischer, rezidivierender ventraler Schulterinstabilität mit knöchernem Glenoiddefekt wurden prospektiv präoperativ, 3 und 12 Monate postoperativ klinisch und radiologisch untersucht. Klinische Parameter waren der Constant-Score (CS), der Rowe-Score (RS) und der „subjective shoulder value“ (SSV), radiologisch wurde zu allen Untersuchungszeitpunkten ein Röntgen und eine Computertomographie des betroffenen Schultergelenks durchgeführt, wodurch das Ausmaß des knöchernen Defekts, die Kavität des Glenoids und die Remodellierung des Spans evaluiert werden konnten.

Ergebnisse

Mittlerer CS (69,40 ± 10,03 präoperativ) und mittlerer RS (57,70 ± 16,47 präoperativ) zeigten nach 12 Monaten statistisch signifikante Verbesserungen (94,20 ± 4,98 bzw. 96,35 ± 3,79). Sieben Patienten waren mit der Operation sehr, 3 ziemlich zufrieden (SSV). Der knöcherne Glenoiddefekt betrug präoperativ im Mittel 18,66 ± 4,40 % und war unmittelbar postoperativ mit 4,55 ± 3,40 % deutlich geringer. Durch die Remodellierung des Spans betrug der Defekt nach 12 Monaten 10,26 ± 3,47 %. Komplikationen traten während des Nachuntersuchungszeitraums nicht auf.

Schlussfolgerung

Die vorliegende Studie konnte erstmals zeigen, dass die arthroskopische Augmentation mittels J-Span bei rezidivierender Schulterinstabilität mit knöchernem Glenoiddefekt nach 12 Monaten klinisch und radiologisch gute Ergebnisse liefert.

Abstract

Background

Glenoid defect is a significant risk factor for recurrent shoulder instability and influences the surgical outcome. In case of a relevant bony Bankart lesion, sole soft-tissue stabilization (Bankart repair) is not recommended due to a high risk of recurrence. As a consequence, various open surgical techniques have been successfully applied for shoulder stabilization with concomitant anterior glenoid defect. However, only a few short-term studies report the outcome of bony glenoid augmentation via arthroscopic techniques. In the following study, 1-year results of clinical and radiographic outcome of all-arthroscopic J-bone grafting are presented.

Material and methods

Ten consecutively admitted patients (9 men, 1 women, mean age 29.1 years) with traumatic recurrent ventral shoulder instability with bony glenoid defect were prospectively evaluated before, 3 and 12 months after all-arthroscopic anatomic glenoid restoration surgery using a J-shaped iliac crest bone graft. Data of interest were a clinical examination, the Constant Score (CS), the Rowe Score (RS), and the Subjective Shoulder Value (SSV). In addition to standard radiographs, a computed tomography was performed at each point in time to evaluate glenoid defect, glenoid cavity, and graft remodeling.

Results

The mean CS (69.40 ± 10.03 preoperatively) and the RS (57.70 ± 16.47 preoperatively) improved significantly to 94.20 ± 4.98 and 96.35 ± 3.79, respectively. In all, 7 patients reported to be very satisfied, while 3 were fairly satisfied (SSV). The average glenoid bone defect (18.66 % ± 4.40 preoperatively) was reduced immediately after the operation to 4.55 % ± 3.40. Due to anatomical glenoid remodeling, the bony defect increased to 10.26 % ± 3.47 after 1 year. No complications were reported and no recurrent instability occurred during the entire follow-up period.

Conclusion

The study showed for the first time that all-arthroscopic anatomic glenoid reconstructive surgery using the J-bone graft provides good clinical and radiological results 12 months after surgery.

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Authors and Affiliations

  1. Orthopädische Abteilung, Krankenhaus der Barmherzigen Schwestern Wien, Stumpergasse 13, 1060, Wien, Österreich

    Fabian Plachel,  Philipp Heuberer, Jakob Schanda,  Leo Pauzenberger,  Bernhard Kriegleder &  Werner Anderl

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  1. Fabian Plachel
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  2. Philipp Heuberer
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Correspondence to Philipp Heuberer.

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Interessenkonflikt

F. Plachel, P. Heuberer, J. Schanda, L. Pauzenberger, B. Kriegleder und W. Anderl geben an, dass kein Interessenkonflikt besteht.

Dr. P. Heuberer und W. Anderl sind bezahlte Berater von Arthrex.

Alle beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Plachel, F., Heuberer, P., Schanda, J. et al. Arthroskopische J-Span-Implantation bei knöchernem Glenoiddefekt. Obere Extremität 11, 119–125 (2016). https://doi.org/10.1007/s11678-015-0321-5

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