Arthroscopic anatomic glenoid reconstruction demonstrates its safety with short-term to medium-term results for anteroinferior shoulder instability: a systematic review

Abstract

Importance Glenoid bone loss can be associated with recurrent anterior shoulder instability and can lead to unsuccessful stabilisation procedures if not addressed. Objective The purpose of this study was to review the currently described techniques for arthroscopic anatomic glenoid reconstruction (AAGR) for anteroinferior shoulder instability and to analyse the results available to date. Evidence review A systematic literature search of three databases (PubMed, Embase and Scopus) was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify relevant articles. Any article describing a surgical technique and/or presenting results related to this technique was included. Quality appraisal was performed using the Risk Of Bias In Non-randomised Studies - of Interventions tool and the Institute of Health Economics Quality Appraisal of Case Series Studies Checklist. Findings Twenty-seven studies published between 2008 and 2019 were identified for inclusion. Clinical results were available for a total of 237 patients across all studies, with age range 16-67. Iliac crest autograft was used in 60% of patients. Iliac crest allograft and distal tibia allograft were used in 22% and 18% of patients, respectively. Distal clavicle autograft, lateral femoral autograft, glenoid allograft and synthetic graft were also described in cadaveric studies or technique papers without results. Capsuloligamentous repair was performed with suture anchors in 95% of patients, while 5% had no soft-tissue repair. Patient satisfaction was high (90%), with low rates of instability (5%). Clinical exam demonstrated satisfactory range of motion, with good outcomes when functional scores were assessed, including Rowe score, constant score, Walch-Duplay score, Western Ontario Shoulder Instability Index (WOSI) and subjective shoulder value. Radiographic evaluation revealed high union rates (97%), but also high rates of resorption. Graft resorption rates averaged between 10% and 32%. Conclusions Current evidence demonstrates that AAGR is a safe procedure with good short-term to medium-term results that is worthy of further study. Level of evidence Level IV, systematic review of level III and IV studies.