POSTER ABSTRACTS - ISAKOS

E-poster #872
The Histopathology of Glenoid Bone Lesions
and Its Relevance to Surgery for Glenohumeral
Instability
Joe F De Beer, Cape Town, SOUTH AFRICA,
Presenter
Chris Paul Roberts, Ipswich, Suffolk, UNITED
KINGDOM
Pol Huysmans, NETHERLANDS
Tim Cresswell, Cape Town, Western Cape, SOUTH
AFRICA
Karin van Rooyen, Cape Town, SOUTH AFRICA
Christo J.F.Muller, Tygerberg, Western Cape,
SOUTH AFRICA
Don F.du Toit, Tygerberg, SOUTH AFRICA
University of Stellenbosch, Tygerberg, SOUTH
AFRICA
INTRODUCTION: The management of bony
lesions associated with glenohumeral instability
has been open to debate. Invariably a significant
period of time elapses between injury and surgery
during which the bony fragment may atrophy and
reduce both in size and in quality.
METHOD: Histomorphometric bone analyses were
prospectively performed on the glenoid bone
fragments harvested during the modified Latarjet
operation. The main purpose of the study was to
assess the viability of the bone.
RESULTS: Biopsies were obtained from 21
patients that had given informed consent.
Median age was 21 years (range 16-50). All were
male patients. The most important sports
identified were rugby (64%) and water sports
(surfing, water polo, water skiing, surfing (21%)).
Mean glenoid bone loss on CT scan was 17%
(range 10-50%). Thirty-three percent had bone loss
greater than 20%.
Gross morphology of gleno-labral fragments
identified a single large fragment (11/21);
dominant large fragment plus smaller fragments
(7/21); multiple fragments (4/21). Single large
fragments comprised 52% of the study. Mean
volume and mass of bony fragments were 2.18 ml
(range 1-3 ml) and 1.64 gms (range 0.43-2.8 g),
respectively. Histology of the specimens revealed
no bone in three of the 21 specimens. Bony
necrosis was present in 8/18 (44%) of the
specimens.
CONCLUSION: From a histopathological point of
view, reattachment of these devitalized bone
fragments by screws or anchors may result in
predictable operative failure and recurrent
instability. We can therefore not support the
practice of repair of bony Bankart lesions based
on the above findings.
E-poster #873
Latarjet Procedure for Glenoid Bone Loss after
Recurrent Dislocations
Joe F De Beer, Cape Town, SOUTH AFRICA,
Presenter
Chris Paul Roberts, Ipswich, Suffolk, UNITED
KINGDOM
Pol Huysmans, NETHERLANDS
Tim Cresswell, Cape Town, Western Cape, SOUTH
AFRICA
Karin van Rooyen, Cape Town, SOUTH AFRICA
Christo J.F. Muller, Tygerberg, Western Cape
SOUTH AFRICA
Johannes Barth, San Antonio, Texas, USA
Don F. du Toit, Tygerberg, SOUTH AFRICA
Stephen S Burkhart, San Antonio, TX, USA
Cape Shoulder Institute, Cape Town, SOUTH
AFRICA
INTRODUCTION: The purpose of this multi-centre
retrospective study was to determine the
outcomes of the Latarjet procedure for shoulder
instability with glenoid bone loss.
METHOD: From March 1996 to December 2002,
102 patients underwent an open Latarjet
procedure by the two senior authors. Forty-six of
them were available for a follow-up.
RESULTS: Mean age of the patients was 26.7 years
old. There were 45 male patients and 1 female
patient. Pre-operative mean forward elevation was
175 degrees, external rotation was 47 degrees,
external rotation from 90 degrees of abduction
was 76 degrees and internal rotation was 83
degrees. All patients had a pre-operative positive
apprehension sign. The mean number of
dislocations before surgery was 15.
The mean follow-up time was 38.5months (range:
12 to 88). Post-operative mean forward elevation
was 179 degrees, external rotation was 54 degrees,
external rotation from 90 degrees of abduction
was 92 degrees and internal rotation was 83
degrees. No patient suffered a further dislocation
although one of them still had a positive
apprehension sign (2.2%). The post-op WALCH
and DUPLAY score was 91.8±8.4 and the
CONSTANT score was 94.2±6.07 (range 79 to 100).
CONCLUSION: Glenoid bone loss represents a
strong indication of a bone grafting procedure to
restore the articular arc of the glenoid and avoid
any further dislocation. The Latarjet procedure
should be considered as the Gold standard for