Allograft Reconstruction for Glenoid Bone Loss in Glenohumeral Instability: A Systematic Review

摘要

Purpose: The aim of this study was to assess clinical outcomes and radiological outcomes after osteochondral allograft reconstruction for glenoid bone loss. Methods: Glenoid bone loss can occur in the setting of recurrent glenohumeral instability and poses a challenge for surgeons. Reconstruction of these defects with allografts has been proposed as an alternative to both arthroscopic stabilization and nonanatomic bony augmentation procedures with autografts. We conducted a systematic review of the literature for studies of any level of evidence that reported clinical or radiological outcomes (or both) after allograft reconstruction for glenoid deficiency in the setting of recurrent shoulder instability. Data collected included study and patient characteristics, surgical technique, outcome scores, range of motion, strength, subjective outcomes, radiological outcomes, and complications. Data from studies with a sample size of at least 5 were pooled in the main analysis. Studies were assessed for the presence of methodological bias. Results: Eight studies met the inclusion criteria and were included in the review. Three studies were deemed eligible for pooled analysis. The study group consisted of 70 shoulders with a mean age of 27.7 years (74.6% of participants were men) and a mean follow-up period of 44.5 +/- 17.7 (range, 32 to 90) months. The mean final Rowe score was 90.6, representing a mean improvement of 57.5. Only 9.8% of patients complained of persistent or unimproved pain, and 93.4% were satisfied. Bony integration of the allograft was documented in 100% of shoulders. Recurrence of glenohumeral dislocation and overall instability were seen in 2.9% and 7.1% of cases, respectively. Conclusions: The current body of Level IV data suggests that allograft reconstruction for glenoid bone loss provides excellent clinical outcomes, low rates of recurrent instability, and high osseous incorporation rates with no evidence of graft resorption.