Arthroscopic Autologous Iliac Crest Bone Grafting For Anterior Shoulder Instability With Glenoid Bone Defects And Related Imaging Studies

Objective:To evaluate clinical efficacy of arthroscopic autologous iliac bone grafting for anterior shoulder instability with glenoid bone defects And to establish integrated Hill-Sachs lesion(HS lesion)measurements by computed tomography(CT)with 3D reconstruction.Then to identify the risk factors for bipolar lesions and to investigated the correlation between glenoid defects and HS lesionMethods:Firstly,from March 2013 to December 2015,30 patients with significant glenoid defects were included in a retrospective study.(28 males,2 females.Aged 17 to 39 years,mean age 26.5 years).For the first 23 cases,the autologous bone was bundled to the glenoid by suture anchors;for the last 7 cases,2 parallel tunnels were made and the graft was then tied to the glenoid.The American Shoulder and Elbow Surgeons(ASES),Constant-Murley and Rowe scores are recorded before surgery and in the postoperative follow-up.All patients take CT and MRI examination after surgery to evaluate the bone block healing.All the data and functional status were statistically analyzed.Secondly,from January 2016 to December 2016,36 patients with anterior shoulder instability were included,and the original CT images were copied and reconstructed via Mimics V17.0.Various measurements were used to address the size of glenoid defects and the HS lesion.Then,the correlation between glenoid defects and HS lesion was investigated.At last,based on the patients' history,the risk factors for bipolar lesions were analyzed statistically using Chi-square test or Logistic regression.Results:1.The surgery was successfully performed on the 30 patients The average follow-up period was 19.6 months(ranged from 12 to 36 months).At final follow-up,the ASES score,Constant-Murley score and Rowe score were found to have improved significantly(P<0.05).The CT taken postoperatively showed that the iliac bone block and the defected glenoid had a pleasant bony healing process.No recurrent dislocation was found in all 30 cases.2.Based on the image results of 36 cases,bipolar lesions were found in 21 cases,isolated HS lesions were detected in 6 cases,isolated glenoid defects were detected in 4 cases and 5 cases were identified as no lesion.The size of glenoid defects and the size of HS lesion increased in tandem.The correlation between the glenoid defects and HS lesion is significant but they were not strongly correlated.Regarding the risk factors for bipolar lesions,playing contact or overhead activities and total dislocation events were closely related to the occurrence of bipolar lesionsConclusions:1.The arthroscopic autologous iliac bone grafting provided excellent clinical outcome and it reconstructed the glenoid in a minimally invasive way.It,s a promising method in treating anterior shoulder instability.2.The correlation between the glenoid defects and HS lesion is significant but they were not strongly correlated.The prevalence of bipolar lesions was 58.3%,and patients playing contact or overhead sports and patients with repetitive dislocations were more likely to have bipolar lesions.