Indications for Glenoid Bone Graft Surgery Associated with Favorable Functional Outcomes: A Systematic Review

Author(s): Paulo HS Lara, Leandro M Ribeiro, Carlos V Andreoli, Alberto C Pochini, Paulo S Belangero, Benno Ejnisman

Background: Bony lesions are prevalent in anterior shoulder instability and can be a signifivant cause of failure of stabilisation procedures if they are not adequately addressed. Determining the best surgical treatments for anterior shoulder instability is debatable, with several procedures developed over time. The bone block procedures showed a lower recurrence when compared to Bankart repair but a higher rate of complications.

Purpose: To determine group of indications for bone block procedures for anterior shoulder instability associated with better functional results. This will help in choosing this type of surgery appropriately for shoulder instability.

Study design: Systematic Review.

Methods: This systematic review was conducted in accordance with the International Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. The studies were subdivided according to the main criteria used to indicate glenoid bone graft surgery, Radiological indications group (R), Radiological and clinical indications group (R + C) and Arthroscopic indications group (A). Only randomized clinical trials and prospective studies were included. The extracted and evaluated outcomes were: functional scores (ROWE, WOSI, Constant, SSV, SANE, and VAS).

Results: In the electronic search conducted in April 2022, 1567 articles were identified. After applying the inclusion criteria, a total of 23 articles were selected for the systematic review. Regarding the functional scores, we observed that group A had a greater number of statistically better results (Constant, SSV and VAS). Regarding the functional scores that are specific for shoulder instability, the group R was the group tha showed statisticatlly better results in the ROWE score (Group R;Mean: 91,9; Group R+C;Mean: 85,4; Group A: 83,3, p<0,001). This highlights the variability of the functional scores used to evaluate the results of bone grafting procedures. Conclusion: The radiographic indications group presented the better results in the specific score for shoulder instability and the arthroscopic indications group presented the better results in general and our systematic review is the first to determine indications for bone block procedures that would lead to better functional outcomes in prospective studies.

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