Arthroscopic autologous scapular spine bone graft combined with Bankart repair for anterior shoulder instability with sub-critical (10%-15%) glenoid bone loss.

Abstract Purpose The purpose of our study is to prove that the autologous scapular spine bone graft is an alternative for the treatment of anterior shoulder instability and the clinical and radiological results are promising. Method From July 2016 to August 2018, patients who were diagnosed as anterior shoulder instability with sub-critical (10%-15%) glenoid bone loss were treated by arthroscopic repair with autologous scapular spine bone graft. The inclusion criteria were: 1. Anterior shoulder instability underwent arthroscopic autologous scapular spine bone graft; 2. Glenoid bone loss was within 10-15%(measured by Sugaya's method); 3. Three complete sets of CT scans (preoperative, postoperative 1-week and postoperative 1-year) available; and 4. Clinical follow-up time was at least two years. The exclusion criteria were: 1. Concomitant rotator cuff tear; 2. Concomitant remplissage or SLAP repair; 3.Previous surgery of the affected shoulder; 4. Open surgery; and 5. Incomplete radiological or clinical follow-up. The pre- and post-operative Constant-Murley score, DASH score, VAS score and range of motion(ROM)were recorded. Computed tomography scan with 3-dimensional reconstruction were obtained at first week post-operation and at one-year post-operation, the graft resorption rate was consequently calculated. Results 27 patients were qualified and enrolled in the study. No severe complication was recorded during follow-up. No re-dislocation or subluxation was found, and the apprehension tests were all negative. At the last follow-up, the mean Constant-Murley score was 89.74±3.71, the mean DASH score was 9.77±5.31, the mean VAS score was 0.74±0.64, which are all improved significantly compared with preoperative scores (P=0.00,0.00,0.00, respectively). At the last follow-up, the ROM including anterior flexion, external rotation by side and the internal rotation were well restored without significant difference compared with the contralateral shoulder (P=0.48,0.08,0.47, respectively). At the postoperative one-year the resorption rate of the bone graft was 19.4%. Conclusion This study found that anterior shoulder instability with sub-critical (10%-15%) glenoid bone loss treated with arthroscopic autologous scapular spine bone graft with suture anchor fixation is safe, and could achieve satisfactory result at short term follow up. Level of Evidence Therapeutic case series