Distal Tibial Allograft for Glenoid Bone Loss Brian J. Cole, MD, - - PowerPoint PPT Presentation

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distal tibial allograft for glenoid bone loss
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Distal Tibial Allograft for Glenoid Bone Loss Brian J. Cole, MD, - - PowerPoint PPT Presentation

Mar 14, 2024 165 likes •392 views

Distal Tibial Allograft for Glenoid Bone Loss Brian J. Cole, MD, MBA Professor, Vice-Chairman, and Managing Partner Department of Orthopedics Chairman of Surgery, Rush OPH Section Head, Rush Cartilage Restoration Center Team Physician,

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Brian J. Cole, MD, MBA Professor, Vice-Chairman, and Managing Partner Department of Orthopedics Chairman of Surgery, Rush OPH Section Head, Rush Cartilage Restoration Center Team Physician, Chicago White Sox and Bulls

Distal Tibial Allograft for Glenoid Bone Loss

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I (and/or my co-authors) have something to disclose.

Detailed disclosure information is available via:

Printed Final Agenda Meeting App Meeting Website www.aana.org/annual

  • r

AAOS Orthopaedic Disclosure Program on the AAOS website at http://www.aaos.org/disclosure

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Shorter glenoid “safe arc”  less resistance dislocation

67% recurrence in patients with bone defect

Arthroscopy 2000

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How Does it Happen?

Acute Attritional

Bone Loss Potentiates Bone Loss

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More Instability = More Bone Loss

Am J Sp Med 2004

  • Bipolar Lesions:
  • 44.2% - 1-5 inst. events
  • 69.0% - 6-10 inst. events
  • 82.8% - ≥11 inst. events
  • Primary vs Recurrent:
  • 33.3% of shoulders with primary

instability

  • 61.8% of shoulders with recurrent

instability

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JAAOS 2009

 Arthroscopic  Incorporate Fragment  Posteroinferior anchor  Remplissage?  Arthroscopic…caution!  Incorporate Fragment  Age, Sport, Frequency  Remplissage…if HS  Open  Coracoid  ICBG  Distal Tibia

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JAAOS 2009

 Arthroscopic  Incorporate Fragment  Posteroinferior anchor  Remplissage?  Arthroscopic…caution!  Incorporate Fragment  Age, Sport, Frequency  Remplissage…if HS  Open  Coracoid  ICBG  Distal Tibia

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What “should” happen…

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Problems with Latarjet

JBJS Br 1995

Radiologic DJD in 10 patients (71%)

  • 25-30% Complication Rate
  • Infection, Instability, Neurologic,

Nonunion, Re-operation

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Distal Tibia Allograft

Arthroscopy 2009

 Availability  Restores Anatomy  Osteochondral  Biologic advantage  Biomechanical support

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Building Blocks of Evidence

Articular Contact Pressures Latarjet vs ICBG

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Varied placement and orientation of iliac crest and Latarjet autograft

Flush placement 2mm proud or recessed

JBJS 2010

Latarjet graft placed flush

Iliac crest placed 2mm proud

FLUSH graft placement optimized GH contact pressure

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Building Blocks of Evidence

Articular Contact Pressures Latarjet vs ICBG Articular Contact Pressures DTA vs Latarjet

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Intact Glenoid Latarjet Reconstruction 30% defect Distal tibial

  • steochondral

allograft

DTA Improved GH CONTACT AREA compared to a Latarjet DTA with lower JOINT PEAK FORCES in ABER compared to the Latarjet

AJSM 2014

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Building Blocks of Evidence

Articular Contact Pressures Latarjet vs ICBG Articular Contact Pressures DTA vs Latarjet Articular Contact Pressures

DTA vs ICBG

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DTA improved GH CONTACT AREA compared to a ICBG

AJSM 2016

ICBG DTA

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Building Blocks of Evidence

Articular Contact Pressures Latarjet vs ICBG Articular Contact Pressures DTA vs Latarjet Articular Contact Pressures

DTA vs ICGB

Clinical Outcomes DTA vs Latarjet

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Arthroscopy 2017

 Indications: >15% Bone Loss  CT at F/U  27 patients at mean 45 months  Improved: ASES, SANE, WOSI  CT at 1.4 year: 89% healing better with lesser angles

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Outcomes Of Latarjet versus Distal Tibia Allograft for Anterior Shoulder Instability Repair: A Prospective Matched Cohort Analysis

Frank RM, Kim J, O’Donnell P, Golijanin P, Verma N, Cole BJ, Bnicholson GP, Romeo AA, Provencher MT

 Indications: >15% Bone Loss  DTA (30) vs Latarjet (30) at min 2 yr (mean, 4 yrs)  Matched: Age, BMI, # prior surgery  Improved: ASES, SANE, WOSI  Laterjet higher ASES (93 vs 87)  Similar re-operation (1 DTA and 2 Latarjet) Longer-Term F/U to determine if DJD and Recurrence Differ

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Conclusions

 Remplissage really used for a different patient in the U.S.  Coracoid associated with excellent L-T results but some morbidity (nerve) and potential for DJD  Distal Tibial Allograft another option without donor site morbidity  May be best for large volume glenoid bone loss and revision scenarios  Translational support  May reduce incidence of DJD

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www.BrianColeMD.com

THANK YOU

First Annual AANA/AOSSM/AAOS SKI COURSE January 31-February 3, 2018 Park City, Utah