Rim reconstruction with autogenous iliac crest for anterior glenoid deficiency: forty-three instability cases followed for 5-19 years

Background The purpose of this study was to evaluate the long-term results of instability patients treated with iliac crest graft glenoid augmentation. Materials and methods Retrospective study including 48 consecutive patients (40 male; mean age 25; range, 17-35). There were 20 primary and 28 revision cases. Three patients declined follow-up examination, and 5 lost to >5 years follow-up. Mean follow-up was 9.2 years (range, 5-19). Reconstruction comprised: iliac crest graft, interposition of the labrum on the burred surface of the graft and capsular re-tensioning. We measured the Oxford Shoulder Instability Score (OSIS) and assessed arthrotic changes and atrophy and fatty infiltration of the subscapularis. Results 8/43 had residual pain, 3/43 had a subjective sensation of instability, 1/43 had a re-dislocation and required re-intervention. The mean OSIS was 18.1 points (12-50) (n = 40). 1/40 developed postoperative subscapularis insufficiency. The mean subscapularis atrophy was 7.4% (37% atrophy to 27% hypertrophy). 2/40 had a relevant fatty infiltration of the SSC muscle stage III to stage IV. 19/40 had mild and 1/40 had a moderate arthrosis. Arthrosis progressed by 1 stage in 7 of 35 shoulders. The mean residual glenoid defect area was 4.0% (0-13.5) and the mean defect width was 8.3% (range, 0-19.2) (n = 40). Conclusion Glenoid rim reconstruction with iliac crest graft was equally effective for patients with primary repair and for failed previous stabilization. It offered the advantage of an anatomic reconstruction with a comparatively good long-term preservation of the joint line.