Fresh distal tibial allograft augmentation may be a viable and effective revision procedure for patients with failed Latarjet procedures, according to published results.
Capt. Matthew T. Provencher, MD, MC, USNR, and colleagues documented the history of shoulder instability of 31 male patients who underwent revision of a failed Latarjet procedure with distal tibial allograft. Researchers assessed and statistically compared outcomes before and after revision using the American Shoulder and Elbow Score, single assessment numerical evaluation (SANE) and Western Ontario Shoulder Index (WOSI). At a minimum of 4 months after surgery, all patients underwent a CT scan of the distal tibial allograft, according to researchers.
Results showed patients had a mean percentage glenoid bone loss of 30.3% before distal tibial allograft augmentation. After Latarjet stabilization, researchers found 35.5% of patients had recurrent shoulder dislocation and 64.5% of patients had recurrent subluxation. Upon physical examination, all patients had symptoms consistent with recurrent shoulder instability, according to results. Researchers noted patients had a mean Samilson and Prieto grade of 0.5. Radiographs showed all cases had two fixation screws, and CT scans showed a mean 78% of the Latarjet coracoid graft had resorbed.
Results showed significant improvements in patient-reported outcome scores preoperatively to postoperatively for the ASES, SANE and WOSI. Researchers noted no cases of recurrence, and 92% of patients had complete union at the glenoid-distal tibial allograft interface based on a final CT scan of the distal tibial revision.
“There is very limited evidence in the literature regarding treatment and eventual outcomes of a failed Latarjet procedure. This study highlighted not only the common presenting patterns of patients with a failed Latarjet procedure, but also investigated the outcomes of treatment with hardware removal, debridement and glenoid restoration with a fresh distal tibial allograft,” Provencher told Healio.com/Orthopedics. “Patients demonstrated significant improvement in outcomes with a high rate of return to duty/activity, as well as excellent distal tibia-glenoid interface healing demonstrated on CT scan. Although this can be a challenging condition to treat, the ability to use a tibial graft has shown very promising results.” – by Casey Tingle
Disclosures: Provencher reports he is a paid consultant for Arthrex and the Joint Restoration Foundation; receives intellectual property royalties from Arthrex; receives compensation for services other than consulting from Arthrex; receives publishing royalties from SLACK Inc.; and received honoraria from Arthrosurface. Please see the study for a list of all other authors’ relevant financial disclosures.