This prospective study followed 7 consecutive patients with recurrent anterior shoulder instability and glenoid bone lesion of 20% were treated with AOT method at our institution between 2019 to 2021. The study population consisted of 5 men and 2 women with a mean age of 35.1 years (range, 17–55). Five injuries were trauma-related. Six dominant shoulders were affected (Table 1). All patients had no undergone prior surgeries. All patients gave informed consent. All surgery procedures were performed by the same senior surgeon.
Table 1
Case | Sex | Age | Cause | Lesion(%) | Dominant Side | Hill-Sachs lesion | Time of dislocation before operation | BMI (kg/m²) | Duration of follow-up (months) |
1 | M | 55 | Traffic accident | 18.3 | Y | Engaging | > 5 | 20.9 | 13 |
2 | F | 50 | Unknown | 17.2 | Y | Nonengaging | > 5 | 22.6 | 14 |
3 | M | 18 | Triathlon | 16.3 | Y | Nonengaging | > 10 | 23.9 | 12 |
4 | F | 51 | Unknown | 15.1 | Y | Nonengaging | > 5 | 25.7 | 15 |
5 | M | 17 | Triathlon | 19.2 | Y | Nonengaging | > 10 | 25 | 12 |
6 | M | 28 | Basketball | 19 | N | Engaging | > 50 | 26 | 7 |
7 | M | 27 | Triathlon | 16.4 | Y | Nonengaging | > 20 | 22.3 | 17 |
Diagnoses were made by means of preoperative data, including history, physical examination, radiographs, and CT scans with 3-dimensional (3D) reconstructions of the glenoid. All preoperative and postoperative images were assessed by the same senior surgeon. We did not include patients with glenoid bone defect greater than 20%. We did the measurements of the glenoid lesion by the perfect circle way, using the percentage of glenoid lesion relative to the surface area of the glenoid on the 3D reconstruction view (Fig. 1a). All patients showed a glenoid bone lesion less than 20% and normal rotator cuff function and a positive anterior apprehension sign. In addition, preoperative clinical assessments including the Rowe score, Oxford Shoulder Score (OSS) and Simple Shoulder Test (SST) were collected. Intraoperative data, including concomitant pathologies, defect size and articular assessment by the senior surgeon, were collected.
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Lanzhou University Second Hospital.
Surgical Technique
After successful general anesthesia, the patient was placed in a prone position with the right lower extremity in a flexible 90° position, routinely disinfected, and a surgical sheet was placed. The AOT procedures were performed by using the Osteochondral Autograft Transfer System (OATS) system (Arthrex, Naples, FL). The arthroscope was routinely inserted and the anterior and posterior cruciate ligaments of the medial and lateral menisci of the knee were examined to be intact. A longitudinal incision of approximately 3 cm was made at the superior medial edge of the right knee patella, and the soft tissues were sequentially separated and the superior medial edge of the femoral talus was exposed. A large amount of saline was used to flush and thoroughly stop the bleeding, and the surgical instruments were counted and the incisions were closed layer by layer with dressings after the gauze was clean. The patient's position was changed to right lateral recumbency with 6 Kg tension traction on the left upper limb, and the surgical sheet was routinely disinfected and spread. Saline with epinephrine was injected into the joint cavity, and an incision of 1.0 cm in length was made 2 cm downward and 2 cm inward from the posterior lateral angle of the left acromion and 1.0 cm outward for the posterior approach and the posterior superior approach, respectively. The Trocar was inserted into the joint cavity and the arthroscope was inserted to examine the left shoulder cavity in a certain order and to remove the hyperplastic synovial tissue. At the 5 o'clock position of the shoulder joint, a bone tunnel of 15 mm in length was drilled with a 6mm drill and the cartilage was removed and implanted into the tunnel. The hyperplastic synovial tissue was cleared and the adhesions were fully released. Then, two 3.0 mm wire anchors were implanted in the 5 o'clock and 3 o'clock directions of the glenoid to close the torn glenoid lip, and the shoulder joint was examined for stability and good mobility. After counting the surgical instruments and gauze, the incisions were closed layer by layer and dressings were applied. (Figure 1b.c.d.e)
Postoperative rehabilitation
The arm was immobilized in a sling and swathed after the surgical procedure was complete. For the first postoperative week, the shoulder was maintained in an abduction sling. For the first 2 to 4 weeks, passive and pendulums range of motion in the scapular plane are started. From the 4 weeks, patients were encouraged to begin active-assisted exercises. At 6 to 8 weeks, the patients begin strengthening. Full return to activity is expected at 4 to 6 months postoperatively.
Outcome Measures
Postoperative data, including recurrence dislocation events, complications, physical examination findings, CT scans and clinical outcomes scores were collected and analysis.