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

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, Chicago White Sox and Bulls

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Arthroscopy 2000 67% recurrence in patients with bone defect Shorter glenoid “safe arc”  less resistance dislocation

How Does it Happen? Bone Loss Potentiates Bone Loss Acute Attritional

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

JAAOS 2009  Arthroscopic  Arthroscopic…caution!  Open  Incorporate Fragment  Coracoid  Incorporate Fragment  Age, Sport, Frequency  ICBG  Posteroinferior anchor  Remplissage…if HS  Distal Tibia  Remplissage?

JAAOS 2009  Arthroscopic…caution!  Arthroscopic  Incorporate Fragment  Incorporate Fragment  Age, Sport, Frequency  Posteroinferior anchor  Remplissage…if HS  Remplissage?  Open  Coracoid  ICBG  Distal Tibia

What “should” happen…

Problems with Latarjet • 25-30% Complication Rate • Infection, Instability, Neurologic, Nonunion, Re-operation JBJS Br 1995 Radiologic DJD in 10 patients (71%)

Distal Tibia Allograft Arthroscopy 2009  Availability  Restores Anatomy  Osteochondral  Biologic advantage  Biomechanical support

Building Blocks of Evidence Latarjet vs Articular Contact ICBG Pressures

JBJS 2010 Latarjet graft placed flush Iliac crest placed 2mm proud Varied placement and orientation of iliac crest and Latarjet autograft Flush placement 2mm proud or recessed FLUSH graft placement optimized GH contact pressure

Building Blocks of Evidence DTA vs Latarjet Articular Contact Pressures Latarjet vs Articular Contact ICBG Pressures

AJSM 2014 Distal tibial Latarjet osteochondral Reconstruction 30% defect allograft Intact Glenoid DTA Improved GH CONTACT AREA compared to a Latarjet DTA with lower JOINT PEAK FORCES in ABER compared to the Latarjet

Building Blocks of Evidence Articular Contact DTA vs ICBG Pressures DTA vs Latarjet Articular Contact Pressures Latarjet vs Articular Contact ICBG Pressures

AJSM 2016 ICBG DTA DTA improved GH CONTACT AREA compared to a ICBG

Building Blocks of Evidence Clinical Outcomes DTA vs Latarjet Articular Contact DTA vs ICGB Pressures DTA vs Latarjet Articular Contact Pressures Latarjet vs Articular Contact ICBG Pressures

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

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

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

THANK YOU First Annual AANA/AOSSM/AAOS SKI COURSE January 31-February 3, 2018 Park City, Utah www.BrianColeMD.com