ARTHROSCOPIC DISTAL TIBIAL ALLOGRAFT ANTERIOR GLENOID RECONSTRUCTION WITH DOUBLE SUTURE-BUTTON FIXATION: TWO-YEAR OUTCOMES

Anterior glenohumeral instability (AGHI) is a common cause of shoulder instability, and while bony reconstruction with coracoid autograft (aka the Latarjet or Bristow-Latarjet procedure) is the gold standard for treatment, other options have been studied such as the distal tibial allograft (DTA) technique. While a promising option, screw fixation of the graft comes with certain risks including hardware complications requiring revision surgery, so a novel technique, arthroscopic DTA with double suture-button fixation, has been proposed and trialled. The purpose of our study is thus to report the outcomes of arthroscopic DTA anterior glenoid reconstruction with double suture-button fixation. A single-surgeon, single-centre, mixed retrospective/prospective cohort review of patients who underwent arthroscopic DTA glenoid reconstruction with double-button suture anchor fixation at a hospital in Edmonton, Alberta between 2018 and 2022. The study included adult patients at least 18 years old at time of study with at least 13% glenoid bone loss and 2 years of follow-up. Patients who consented for a telephone interview were contacted to assess patient-reported outcomes. Chart reviews were also completed to assess for radiographic and clinical outcomes. Primary outcomes were failure rate, complication rate including infection, neurovascular injury, revision rate, re-operation rate, and patient reported outcome measures. Fourty three patients (mean age 30, range 18–63, 88% male) were included in the chart review. Mean follow-up was 45.3mo (range 24.9–66.7). Fourteen of 43 patients (33%) were revision procedures. Mean pre-operative glenoid bone loss was 32% (range 13–48%). 100% had Hill-Sachs lesions. Four (10%) patients underwent an associated Remplissage. Objective recurrent instability was observed in seven (16%) patients, of which two have undergone further stabilization surgery, two are waiting revision stabilization, two have not yet decided about revision surgery, and one is awaiting a shoulder replacement. One (2%) patient required reoperation for loose suture material, resulting in a total reoperation rate of eight (19%). The study was not powered to identify risk factors for failure, and odds ratios did not achieve statistical significance for patients with a history of epilepsy (OR 4.4, p = 0.15), smoking (OR 6.8, p = 0.08), and substance use (OR 1.8, p = 0.81) While the objective failure rate in this cohort was a very promising 12%, subjective symptoms of instability persisted in 7/23 (30%) interviewed. Surprisingly, a similarly large number complained of post-operative stiffness. The overall re-operation rate was 18% in this challenging population.