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Outcomes are comparable using free bone block autografts versus allografts for the management of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of “The Non-Latarjet”

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Glenoid augmentation using free bone blocks for anterior shoulder instability has been proposed as an alternative to or bail-out for the Latarjet procedure. The purpose of this investigation was to systematically review and compare outcomes of patients undergoing glenoid augmentation using free bone block autografts versus allografts.

Methods

A systematic review using PubMed, MEDLINE, Embase, and the Cochrane Library databases was performed in line with the PRISMA statement. Studies reporting outcomes of patients treated with free bone block procedures for anterior shoulder instability with minimum 2-year follow-up were included. Random effects modelling was used to compare patient-reported outcomes, return to sports, recurrent instability, non-instability related complications, and development of arthritis between free bone block autografts and allografts.

Results

Eighteen studies comprising of 623 patients met the inclusion criteria for this investigation. There were six studies reporting on the use of allografts (of these, two used distal tibial, three iliac crest, and one femoral head allograft) in 173 patients and twelve studies utilizing autografts (of these, ten used iliac crest and two used free coracoid autograft) in 450 patients. Mean age was 28.7 ± 4.1 years for the allograft group and 27.8 ± 3.8 years for the autograft group (n.s). Mean follow-up was 98 months in autograft studies and 50.8 months for allograft studies (range 24–444 months, n.s). Overall mean increase in Rowe score was 56.2 with comparable increases between autografts and allografts (n.s). Pooled recurrent instability rates were 3% (95% CI, 1–7%; I2 = 77%) and did not differ between the groups (n.s). Arthritic progression was evident in 11% of autografts (95% CI, 2–27%; I2 = 90%) and 1% (95% CI, 0–8%; I2 = 63%) of allografts (n.s). The overall incidence of non-instability related complications was 5% (95% CI, 2–10%; I2 = 81%) and was similar between the groups (n.s). Pooled return to sports rate was 88% (95% CI, 76–96%; I2 = 76%).

Conclusion

Glenoid augmentation using free bone block autograft or allograft in the setting of recurrent anterior shoulder instability with glenoid bone loss is effective and safe. Outcomes and complication incidence using autografts and allografts were comparable. Due to the high degree of heterogeneity in the data and outcomes reported in available studies, which consist primarily of retrospective case series, future prospective trials investigating long-term outcomes using free bone block autograft versus allograft for anterior shoulder instability with glenoid bone loss are warranted.

Level of evidence

IV.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not for-profit sectors.

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Authors and Affiliations

  1. Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA

    Ron Gilat, Stephanie E. Wong, Ophelie Lavoie-Gagne, Eric D. Haunschild, Michael C. Fu, Jorge Chahla, Brian Forsythe & Brian J. Cole

  2. Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel

    Ron Gilat

  3. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Derrick M. Knapik

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  1. Ron Gilat
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Contributions

RG: conceptualization, project administration, data curation, writing—original draft, writing—review and editing. OL-G: data curation, writing—original draft, statistics. EDH: data curation, writing—original draft. DMK: data curation, writing—original draft. SW: writing—original draft. MCF: writing—original draft and review and editing. BF: writing, reviewing and editing. JC: writing—review and editing. BJC: conceptualization, project administration; writing—original draft, writing—review and editing. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

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Correspondence to Ron Gilat.

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Conflict of interest

Dr. Forsythe reports grants from Arthrex, Inc, personal fees from Elsevier, other from Jace Medical, grants from Smith & Nephew, personal fees from Stryker, outside the submitted work. Dr. Cole reports grants, personal fees and non-financial support from Arthrex Inc., during the conduct of the study; other from Aesculap, other from Athletico, personal fees and other from Elsevier publishing, other from JRF Ortho, other from NIH, personal fees and other from OTSM, personal fees from Ossio, personal fees and other from Regentis, other from Smith and Nephew, outside the submitted work;.Dr. Cole reports grants, personal fees and non-financial support from Arthrex Inc., during the conduct of the study; other from Aesculap, other from Athletico, personal fees and other from Elsevier publishing, other from JRF Ortho, other from NIH, personal fees and other from OTSM, personal fees from Ossio, personal fees and other from Regentis, other from Smith and Nephew, outside the submitted work. Dr. Chahla reports—Unpaid consultant—Arthrex, CONMED Linvatec, Smith & Nephew. No conflict of interest to declare regarding this study. Other author(s) declare(s) that there is no conflict of interest.

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Ethical approval was not sought for this article, because this was a systematic review and meta-analysis of already published studies only. All studies included had declared ethical approval seperately.

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Informed consent was not sought for this article, because this was a systematic review and meta-analysis without the enrollment of any new patients.

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Gilat, R., Wong, S.E., Lavoie-Gagne, O. et al. Outcomes are comparable using free bone block autografts versus allografts for the management of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of “The Non-Latarjet”. Knee Surg Sports Traumatol Arthrosc 29, 2159–2174 (2021). https://doi.org/10.1007/s00167-020-06194-z

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