CT-scan Evaluation of Osteointegration and Osteolysis in Different Graft Types and Surgical Techniques for the Treatment of Shoulder Instability

Document Type : RESEARCH PAPER

Authors

1 Department of Shoulder Surgery, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy

2 School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano Via Festa del Perdono 7, 20122 Milano, Italy

3 Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy

4 Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133 Milano, Italy

Abstract

Background: Bone graft is often needed in treating anterior shoulder instability in glenoid bone loss and graft 
integration is crucial in achieving good results. This study aimed to evaluate bone graft remodeling in different 
techniques for shoulder anterior-inferior instability. 
Methods: Graft osteointegration and osteolysis were retrospectively evaluated with CT-scan imaging performed 
6 to 12 months after surgery to compare the outcome of three procedures: Latarjet, bone block with allograft, and 
bone block with xenograft. Screw fixation and double endobuttons fixation were also compared. 
Results: CT scans of 130 patients were analyzed. Of these, 30 (23%) were performed after the bone block procedure 
with xenograft and endobuttons fixation, 55 (42%) after the bone block procedure with allograft and endobuttons 
fixation, 13 (10%) Latarjet with screw fixation and 32 (25%) Latarjet with endobuttons fixation. The prevalence of 
osteolysis was significantly inferior (P<.01) in the bone block procedure compared to the Latarjet procedure (11.7 
% vs. 28.8 %). Bone integration was higher in bone block procedures (90.5%) than in Latarjet (84.4%), but the 
difference was not statistically significant. Among the Latarjet procedures, endobuttons fixation resulted in a higher 
integration rate (87.5% vs. 73.6%) and lower osteolysis rate than screw fixation (24.6% vs. 38.5%), despite these 
differences did not reach a statistical significance. Among the bone block procedures, using a xenograft resulted in a 
lower osteolysis rate (6.7%) than an allograft (14.5%), but the result was not statistically significant. 
Conclusion: This study shows a significantly lower rate of graft osteolysis after bone block procedures compared 
to Latarjet procedure between 6 and 12 months postoperatively. Moreover, our findings suggest good results in 
osteolysis and graft integration with xenograft compared to allograft and double endobuttons fixation compared to 
screw fixation, despite these differences being not-significant. Further studies on this topic are needed to confirm 
our results at a longer follow-up and thoroughly investigate the clinical relevance of these findings.
Level of evidence: III

Keywords

Main Subjects


1. Milano G, Grasso A, Russo A, et al. Analysis of risk 
factors for glenoid bone defect in anterior shoulder 
instability. Am J Sports Med. 2011;39(9):1870–6. doi: 
10.1177/0363546511411699. 
2. Piasecki DP, Verma NN, Romeo AA, Levine WN, Bach 
BR, Provencher MT. Glenoid bone deficiency in 
recurrent anterior shoulder instability: diagnosis and 
management. J Am Acad Orthop Surg. 2009;17(8):482–
93. doi: 10.5435/00124635-200908000-00002. 
3. Bliven KCH, Parr GP. Outcomes of the Latarjet 
Procedure Compared With Bankart Repair for 
Recurrent Traumatic Anterior Shoulder Instability. 
J Athl Train. 2018;53(2):181–3. doi: 10.4085/1062-
6050-232-16. 
4. Sayegh ET, Mascarenhas R, Chalmers PN, Cole BJ, 
Verma NN, Romeo AA. Allograft reconstruction for 
glenoid bone loss in glenohumeral instability: a 
systematic review. Arthroscopy. 2014;30(12):1642–
9. doi: 10.1016/j.arthro.2014.05.007. 
5. Gilat R, Lavoie-Gagne O, Haunschild ED, et 
al. Outcomes of the Latarjet procedure with 
minimum 5- and 10-year follow-up: A systematic 
review. Shoulder Elbow. 2020;12(5):315–29. doi: 
10.1177/1758573220945318. 
6. Gilat R, Wong SE, Lavoie-Gagne O, et al. Outcomes are 
comparable using free bone block autografts versus 
allografts for the management of anterior shoulder 
instability with glenoid bone loss: a systematic review 
and meta-analysis of «The Non-Latarjet». Knee Surg 
Sports Traumatol Arthrosc. 2021;29(7):2159–74. doi: 
10.1007/s00167-020-06194-z.
7. Russo R, Maiotti M, Taverna E, Rao C. Arthroscopic 
Bone Graft Procedure Combined With Arthroscopic 
Subscapularis Augmentation for Recurrent Anterior 
Instability With Glenoid Bone Defect. Arthrosc Tech. 
2018;7(6):e623–32. doi: 10.1016/j.eats.2018.02.009. 
8. Sigrist B, Ferguson S, Boehm E, Jung C, Scheibel M, 
Moroder P. The Biomechanical Effect of Bone Grafting 
and Bone Graft Remodeling in Patients With Anterior 
Shoulder Instability. Am J Sports Med. 2020;48(8):1857–
64. doi: 10.1177/0363546520919958.
9. Malahias M-A, Chytas D, Raoulis V, Chronopoulos E, 
Brilakis E, Antonogiannakis E. Iliac Crest Bone Grafting 
for the Management of Anterior Shoulder Instability in 
Patients with Glenoid Bone Loss: a Systematic Review 
of Contemporary Literature. Sports Med Open. 2020; 
6(1):12. doi: 10.1186/s40798-020-0240-x. 
10.Di Giacomo G, Costantini A, de Gasperis N, et al. 
Coracoid graft osteolysis after the Latarjet procedure 
for anteroinferior shoulder instability: a computed 
tomography scan study of twenty-six patients. J 
Shoulder Elbow Surg. 2011;20(6):989–95. doi: 
10.1016/j.jse.2010.11.016. 
11.Kee YM, Kim JY, Kim HJ, Sinha S, Rhee Y-G. Fate of 
coracoid grafts after the Latarjet procedure: will be 
analogous to the original glenoid by remodelling. Knee 
Surg Sports Traumatol Arthrosc. 2018;26(3):926–32. 
doi: 10.1007/s00167-017-4808-z. 
12.Moroder P, Hirzinger C, Lederer S, et al. Restoration 
of anterior glenoid bone defects in posttraumatic 
recurrent anterior shoulder instability using the 
J-bone graft shows anatomic graft remodeling. 
Am J Sports Med. 2012;40(7):1544–50. doi: 
10.1177/0363546512446681. 
13.Alp NB, Doğan O, Yılmaz TG, et al. Understanding the 
causes behind coracoid graft osteolysıs in latarjet procedure (finite element analysis and comparison of 
three fixation methods). Orthop Traumatol Surg Res. 
2020;106(1):53–9. doi: 10.1016/j.otsr.2019.11.007. 
14.Boileau P, Gendre P, Baba M, et al. A guided surgical 
approach and novel fixation method for arthroscopic 
Latarjet. J Shoulder Elbow Surg. 2016;25(1):78–89. 
doi: 10.1016/j.jse.2015.06.001. 
15.Balestro J-C, Young A, Maccioni C, Walch G. Graft 
osteolysis and recurrent instability after the Latarjet 
procedure performed with bioabsorbable screw 
fixation. J Shoulder Elbow Surg. 2015;24(5):711–8. 
doi: 10.1016/j.jse.2014.07.014. 
16. Taverna E, D’Ambrosi R, Perfetti C, Garavaglia G. 
Arthroscopic bone graft procedure for anterior inferior 
glenohumeral instability. Arthrosc Tech. 2014;3(6):e653-
660. doi: 10.1016/j.eats.2014.08.002. 
17.Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie 
R, Kochhar T. The arthroscopic Latarjet procedure 
for the treatment of anterior shoulder instability. 
Arthroscopy. 2007;23(11):1242.e1-5. doi: 10.1016/j.
arthro.2007.06.008. 
18.Taverna E, Golanò P, Pascale V, Battistella F. An 
arthroscopic bone graft procedure for treating 
anterior-inferior glenohumeral instability. Knee Surg 
Sports Traumatol Arthrosc. 2008;16(9):872–5. doi: 
10.1007/s00167-008-0541-y. 
19.Taverna E, Ufenast H, Broffoni L, Garavaglia G. 
Arthroscopically assisted Latarjet procedure: A 
new surgical approach for accurate coracoid graft 
placement and compression. Int J Shoulder Surg. 
2013;7(3):120–3. doi: 10.4103/0973-6042.118912. 
20.Young AA, Maia R, Berhouet J, Walch G. Open Latarjet 
procedure for management of bone loss in anterior 
instability of the glenohumeral joint. J Shoulder 
Elbow Surg. 2011;20(2):S61–9. doi: 10.1016/j.
jse.2010.07.022.
21.Zhu Y-M, Jiang C-Y, Lu Y, Li F-L, Wu G. Coracoid 
bone graft resorption after Latarjet procedure is 
underestimated: a new classification system and a 
clinical review with computed tomography evaluation. 
J Shoulder Elbow Surg. 2015;24(11):1782–8. doi: 
10.1016/j.jse.2015.05.039. 
22.Lafosse L, Boyle S. Arthroscopic Latarjet procedure. 
J Shoulder Elbow Surg. 2010;19(2 Suppl):2–12. doi: 
10.1016/j.jse.2009.12.010. 
23.Cassagnaud X, Maynou C, Mestdagh H. Clinical and 
computed tomography results of 106 Latarjet-Patte 
procedures at mean 7.5 year follow-up. Revue de 
Chirurgie Orthopedique et Reparatrice de L’appareil 
Moteur. 2003; 89(8):683-92. 
24.Allain J, Goutallier D, Glorion C. Long-term results 
of the Latarjet procedure for the treatment of 
anterior instability of the shoulder. J Bone Joint Surg 
Am.1998;80(6):841–52. doi: 10.2106/00004623-
199806000-00008. 
25.Provencher MT, Ghodadra N, LeClere L, Solomon 
DJ, Romeo AA. Anatomic osteochondral glenoid 
reconstruction for recurrent glenohumeral instability 
with glenoid deficiency using a distal tibia allograft. 
Arthroscopy. 2009;25(4):446–52. doi: 10.1016/j.
arthro.2008.10.017.
26.Mochizuki Y, Hachisuka H, Kashiwagi K, Oomae H, 
Yokoya S, Ochi M. Arthroscopic autologous bone 
graft with arthroscopic Bankart repair for a large 
bony defect lesion caused by recurrent shoulder 
dislocation. Arthroscopy. 2007;23(6):677.e1-4. doi: 
10.1016/j.arthro.2006.01.024. 
27.Levine WN, Richmond JC, Donaldson WR. Use of the 
suture anchor in open Bankart reconstruction. A 
follow-up report. Am J Sports Med. 1994;22(5):723–
6. doi: 10.1177/036354659402200525. 
28.Zhao J, Huangfu X, Yang X, Xie G, Xu C. Arthroscopic 
glenoid bone grafting with nonrigid fixation for 
anterior shoulder instability: 52 patients with 2- to 
5-year follow-up. Am J Sports Med. 2014;42(4):831–
9. doi: 10.1177/0363546513519227.
29.Moroder P, Schulz E, Wierer G, et al. Neer Award 2019: 
Latarjet procedure vs. iliac crest bone graft transfer 
for treatment of anterior shoulder instability with 
glenoid bone loss: a prospective randomized trial. J 
Shoulder Elbow Surg. 2019;28(7):1298–307. doi: 
10.1016/j.jse.2019.03.035. 
30.Guity MR, Roques B, Mansat P, Bellumore Y, Mansat 
M. Painful or unstable shoulder after coracoid 
transfer: result of surgical treatment. Rev Chir Orthop 
Reparatrice Appar Mot. 2002;88(4):349–58. 
31.Di Giacomo G, de Gasperis N, Costantini A, De Vita 
A, Beccaglia MAR, Pouliart N. Does the presence 
of glenoid bone loss influence coracoid bone graft 
osteolysis after the Latarjet procedure? A computed 
tomography scan study in 2 groups of patients with 
and without glenoid bone loss. J Shoulder Elbow Surg. 
2014;23(4):514–8. doi: 10.1016/j.jse.2013.10.005.