Distal radius allograft may offer novel glenoid reconstruction option
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Key takeaways:
- Distal radius allograft had a greater mean graft length than distal tibia allograft.
- Distal radius allograft also had a more acute radius of curvature than distal tibia allograft.
WASHINGTON — Results presented here showed distal radius allografts had greater mean graft length and more acute radius of curvature than distal tibia allografts and may be a novel glenoid reconstruction option.
To determine whether distal radius allograft was a comparable option to distal tibia allograft for glenoid reconstruction, Adam Khan, MD, and colleagues measured glenoid radius of curvature in both the superior to inferior and anterior to posterior planes, graft length in the superior to inferior plane, graft fit post-fixation, bony radius of the curvature and bone mineral density in 18 human specimens (6 shoulder, 6 wrist, 6 tibia) without OA or prior surgical procedures.
“The distal tibia has been described and shown good clinical results and it does a nice job of reconstructing the glenoid in the superior to inferior radius of curvature, but it does not anatomically reconstruct the glenoid anterior to posterior,” Khan said in his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “Furthermore, considering the availability of grafts as well as costs, it’s important to consider other options.”
Researchers found that distal radius allograft had a greater mean graft length and a more acute radius of curvature interiorly compared with distal tibia allograft. In addition, researchers found that bone mineral density was not significantly diminished with distal radius allograft.
Khan also said that distal radius allografts could potentially allow dorsal radiocarpal ligaments to be preserved and utilized for anterior capsular reconstruction.
“This is a novel option that we can consider, and further biomechanical testing is ongoing,” Khan said.
Perspective
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Adam Khan, MD, and colleagues should be highly commended for their innovative study on the use of distal radius allograft for glenoid reconstruction. While this “out-of-the-box” idea for a graft source remains in experimental stages of cadaveric testing, their early results demonstrate promising data regarding a more anatomic restoration of the glenoid compared to the distal tibial allograft, without differences in bone density. The combination of high failure rates with traditional arthroscopic Bankart, improved understanding of bipolar bone loss and high risks of complications following a traditional Latarjet have all contributed to a rapid growth in the current instability literature exploring treatment options that attempt to mitigate the issues related to bone loss while minimizing complications, including the use of free-standing bone grafts.
Limitations with this study, however, exist and much remains unknown. Does the cartilage thickness and its contribution to radius of curvature matter for the distal radius allograft or other alternative bone graft choices? Is a fresh osteochondral allograft superior to a frozen allograft? Are allografts and autografts equivalent? What fixation methods are preferred, and how can techniques be standardized to obtain reproducible outcomes in a cost-effective manner? Studies like this that push the envelope are needed so that we can answer these questions and achieve better outcomes for our patients. I look forward to the continued work of these investigators as they translate their research to the clinical setting.
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Khan A, et al. Paper 2. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 12-16, 2023; Washington, D.C.
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