TY - JOUR
T1 - High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes
T2 - a systematic review and meta-analysis
AU - Rutgers, Cain
AU - Verweij, Lukas P. E.
AU - Schuit, Alexander A.
AU - Sierevelt, Inger N.
AU - Jamaludin, Faridi S.
AU - van der Woude, Henk-Jan
AU - van den Bekerom, Michel P. J.
N1 - Publisher Copyright: © 2022, The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
PY - 2023
Y1 - 2023
N2 - Purpose: Bone augmentation techniques show a relatively high complication rate, which might be due to graft non-union and resorption. It is unclear which augmentation techniques demonstrate the highest amount of non-union and resorption and whether this leads to worse clinical or functional outcomes. Therefore, the aim of this review was (i) to compare non-union and resorption rates between surgical approaches, procedures, graft types, donor sites and fixation methods regarding clinical and functional outcomes and (ii) determine whether high non-union or resorption rates lead to less favorable clinical or functional outcomes. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements were followed. PubMed, EMBASE (Ovid) and Cochrane Library were searched on December 15th 2021 for studies examining bone graft non-union or resorption using radiograph or CT following glenoid augmentation to treat anterior shoulder dislocation. Results: The search resulted in 103 inclusions, comprising 5,128 glenoid augmentations. When comparing pooled proportions of bony union, graft fracture rate, hardware failure rate, recurrence rate, return to sports and Rowe score, most results were similar between approaches, procedures, graft types, donor sites and fixation methods. High resorption rates were seen for allograft augmentation (74.3; 95% CI: 39.8–92.7) compared to autograft augmentation (15.5; 95% CI 10.1–23.2), but this was not associated with higher recurrence rates or worse clinical outcomes. Meta-analyses (8 studies; 494 patients) demonstrated no difference in incomplete and complete non-union rates between arthroscopic and open procedures; however, both analyses showed substantial heterogeneity. Higher partial resorption rates were observed on CT (48.0; 95% CI 43.3–52.7) compared to radiograph (14.1; 95% CI 10.9–18.1). Three studies comprising 267 shoulders demonstrated a higher rate of non-union and recurrence in smokers, whereas one study comprising 38 shoulders did not. Conclusion: Non-union and resorption rates were similar among procedures, grafts and fixation methods. Higher resorption rates were observed in allografts, but this was not associated with higher recurrence rates or worse clinical outcomes. Pooling data demonstrated substantial heterogeneity and definitions varied among studies, warranting more standardized measuring. Level of evidence: IV.
AB - Purpose: Bone augmentation techniques show a relatively high complication rate, which might be due to graft non-union and resorption. It is unclear which augmentation techniques demonstrate the highest amount of non-union and resorption and whether this leads to worse clinical or functional outcomes. Therefore, the aim of this review was (i) to compare non-union and resorption rates between surgical approaches, procedures, graft types, donor sites and fixation methods regarding clinical and functional outcomes and (ii) determine whether high non-union or resorption rates lead to less favorable clinical or functional outcomes. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements were followed. PubMed, EMBASE (Ovid) and Cochrane Library were searched on December 15th 2021 for studies examining bone graft non-union or resorption using radiograph or CT following glenoid augmentation to treat anterior shoulder dislocation. Results: The search resulted in 103 inclusions, comprising 5,128 glenoid augmentations. When comparing pooled proportions of bony union, graft fracture rate, hardware failure rate, recurrence rate, return to sports and Rowe score, most results were similar between approaches, procedures, graft types, donor sites and fixation methods. High resorption rates were seen for allograft augmentation (74.3; 95% CI: 39.8–92.7) compared to autograft augmentation (15.5; 95% CI 10.1–23.2), but this was not associated with higher recurrence rates or worse clinical outcomes. Meta-analyses (8 studies; 494 patients) demonstrated no difference in incomplete and complete non-union rates between arthroscopic and open procedures; however, both analyses showed substantial heterogeneity. Higher partial resorption rates were observed on CT (48.0; 95% CI 43.3–52.7) compared to radiograph (14.1; 95% CI 10.9–18.1). Three studies comprising 267 shoulders demonstrated a higher rate of non-union and recurrence in smokers, whereas one study comprising 38 shoulders did not. Conclusion: Non-union and resorption rates were similar among procedures, grafts and fixation methods. Higher resorption rates were observed in allografts, but this was not associated with higher recurrence rates or worse clinical outcomes. Pooling data demonstrated substantial heterogeneity and definitions varied among studies, warranting more standardized measuring. Level of evidence: IV.
KW - Allografts
KW - Bone augmentation
KW - Bone grafts
KW - Bone union
KW - Bony stabilization
KW - Imaging and radiology
KW - Joint stabilization surgery
KW - Shoulder injuries
KW - Shoulder instability
KW - Sports medicine
UR - http://www.scopus.com/inward/record.url?scp=85143901197&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00167-022-07267-x
DO - https://doi.org/10.1007/s00167-022-07267-x
M3 - Review article
C2 - 36515733
SN - 0942-2056
JO - Knee surgery, sports traumatology, arthroscopy
JF - Knee surgery, sports traumatology, arthroscopy
ER -