Clinical Outcomes and Graft Resorption After Metal-Free Bone Block Suture Tape Cerclage Fixation for Recurrent Anterior Shoulder Instability: A Computed Tomography Analysis.

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.

Cambios Degenerativos y Evaluación Funcional de Fracturas Intraarticulares de Tobillo en Pacientes Pediatricos / Degenerative Changes and Functional Evaluation of Intraarticular Ankle Fractures in Pediatric Patients

Introducción Las fracturas de tobillo representan el 12% de las fracturas en la edad pediátrica. Planteamos la hipótesis que los pacientes con fracturas intraarticulares de tobillo tendrán un excelente resultado funcional y no presentarán cambios degenerativos articulares a los 6 meses post cirugía. El objetivo del estudio es realizar un analisis del resultado funcional, así como la presencia de cambios radiologicos degenerativos precoces en el seguimiento de pacientes con fracturas intra-articulares de tobillo tratadas en nuestro centro. Materiales y Métodos Estudio de Cohorte retrospectivo, se recolectaron datos de pacientes con fracturas intra-articulares de tobillo entre 2012 y 2016. Se clasificaron y evaluaron mediante score AOFAS y radiografías para clasificar según Van Dijk. Resultados La diferencia promedio de edad entre las fracturas triplanares y tillaux es de 17 meses (p: 0.038). La media de Score AOFAS fue de 85,2%. El 88.8% refiere dolor en relación a actividades cotidianas, a pesar de tener excelentes o buenos resultados funcionales. No hay correlación significativa entre los resultados de AOFAS en pacientes con fracturas transicionales y no transicionales., 43,4% presentaron estadio 0, 43,4% estadio I y 13% estadio II de Van Dijk. Ningún caso presento estadio III. Discusión En base a los hallazgos de este estudio, y al contrario de lo hipotetizado, la mayoría de los pacientes tienen un buen resultado funcional tras el manejo de las fracturas intraarticulares de tobillo y no excelente como se pensaba. Existe un grupo de pacientes que mostró cambios degenerativos precoces demostrables por radiografía.

Background Ankle fractures represent 12% of fractures in pediatric age. We hypothesized that patients with intra-articular ankle fractures will have an excellent functional result and will not present degenerative joint changes 6 months after surgery. The objective of the study is to carry out an analysis of the functional result, as well as the presence of early degenerative radiological changes in the follow-up of patients with intra-articular ankle fractures treated in our center. Methods Retrospective cohort study, data were collected from patients with intra-articular ankle fractures between 2012 and 2016. They were classified and evaluated using AOFAS score and radiographs to classify according to Van Dijk. Results The average age difference between triplanar and tillaux fractures is 17 months (p: 0.038). The mean AOFAS Score was 85.2%. 88.8% reported pain in relation to daily activities, despite having excellent or good functional results. There is no significant correlation between the AOFAS results in patients with transitional and non-transitional fractures. 43.4% had stage 0, 43.4% stage I, and 13% stage II Van Dijk. No case presented stage III. Discussion Based on the findings of this study, and contrary to the hypothesized, most patients have a good functional result after the management of intra-articular ankle fractures and not excellent as previously thought. There is a group of patients who showed early degenerative changes demonstrable by radiography.