Acceptable Long-term Outcomes of Arthroscopic Bone Grafting for Recurrent Posterior Shoulder Instability: minimum follow-up of 5 years.

Camenzind, Roland Stefan; Becerra, Javier Martin; Gossing, Louis; Serane-Fresnel, Julien; Wagner, Eric R; Lafosse, Laurent

PURPOSE The purpose of this study was to examine the long-term clinical outcome associated with arthroscopically placed autologous iliac crest bone graft (ICBG) for recurrent posterior shoulder instability. METHODS From January 2008 to December 2013 patients treated with posterior ICBG and a minimum follow-up of 5 years were included. Clinical outcome of patients operated with a posterior ICBG was analyzed with multiple patient-reported outcome measures included Constant (CS), American Shoulder and Elbow Surgeons (ASES), Walch-Duplay, and Rowe score, shoulder subjective value (SSV) and pain visual analog score (VAS). Patient satisfaction was assessed by asking the patients their overall level of satisfaction at last follow-up on a 1 to 10 scale. RESULTS 18 patients (19 shoulders) were included. At a mean follow-up of 7.3 years (range, 5 to 10), patients had significant improvements in their mean CS from 63 (SD 18) to 80 (SD 18; p = 0.005), ASES from 57 (SD 18) to 81 (SD 18; p = 0.003), Walch-Duplay from 34 (SD 31) to 79 (SD 22; p < 0.001) and Rowe score from 37 (SD 23) to 79 (SD 24; p < 0.001). Pain level decreased from 5.6 (SD 2.5) preoperative to 2.3 (SD 2.3; p < 0.001) and SSV improved 58 (SD 20) to 76 (SD 24; p = 0.002). Global satisfaction with the procedure was 8.4 (SD 2.1). Clinical significance was met or exceeded by 84% for CS and 89% of the patients for ASES and 95% met or exceeded satisfaction threshold for CS. There were 7 shoulders (37%) re-operated for symptomatic screw irritation. CONCLUSION This series reporting on the long-term follow-up after arthroscopic posterior ICBG for recurrent posterior shoulder instability demonstrates despite a high number of reoperation for symptomatic screw irritation its effectiveness with acceptable clinical outcomes and satisfied patients. LEVEL OF EVIDENCE IV, Therapeutic Case Series.