Bony augmentation of the glenoid in glenohumeral instability. Overview of current fixation methods

Wafaisade A; Eckl L; Deichsel A; Ackermann J; Kittl C; Laky B; Munch LN; Mathis DT; Merkely G,Eggeling L; Schuttler KF; D'Ambrosio R; Schmidt A; Gunther D; Arbeitsgemeinschaft Arthroskopie AGA

Zusammenfassung

Recurrent anterior shoulder instability frequently leads to anterior glenoid bone loss. This glenoid erosion associated with chronic instability is increasingly treated with bony augmentation of the anterior glenoid in order to adequately stabilize the glenohumeral joint. Various techniques are now used for fixation of the bone grafts. While screw fixation has traditionally been applied, suture button constructs ("suture buttons" or "button reconstruction"), suture cerclage, and suture anchor techniques have been increasingly utilized to avoid complications associated with usage of screws. Biomechanical studies consistently show that in screw fixation, both the number of screws and the use of washers significantly increase construct stiffness and load to failure. When comparing button fixation to screw fixation, mixed results have been reported. However, it has been shown that all constructs using two metal screws, as well as the majority of button and anchor constructs, can withstand glenohumeral loads representative of activities of daily living. Clinical and radiographic studies report comparable outcomes for both screw-based and suture-based fixation methods, with evidence suggesting increased bone resorption in screw fixation. Although the novel techniques are associated with a slightly higher rate of recurrent instability, overall rates of reoperation and complications are lower.