PURPOSE
To assess variations in distal radius morphology to identify factors that may influence optimal graft selection in glenoid reconstruction.
METHODS
A single-institution, retrospective database of wrist computed tomography scans was reviewed to identify patients with intact, uninjured distal radii. Exclusion criteria included fractures, hardware, or cysts in the distal radius and inadequate computed tomography views or quality. Patient age at the time of computed tomography scan was categorized into <30, 30 to 50, and >50 years, and sex was recorded. Measurements included coronal and sagittal radius of curvature (ROC) and axial area, perimeter, and bone mineral density (BMD). These parameters were compared across different age groups and between sexes, with subgroup analyses and multivariable linear regression performed.
RESULTS
A total of 100 patients were included, with a mean age of 42.6 ± 18.3 years (range: 18-88), and 54% were men. Men had a significantly greater mean ROC than women in both coronal (26.5 ± 5.0 vs 23.5 ± 4.2 mm, P = .002) and sagittal (12.6 ± 2.1 vs 11.1 ± 1.4 mm, P < .001) planes. Mean area, perimeter, and BMD were also significantly higher in men compared with women across the total cohort and within all age groups (P < .05). BMD varied across age groups, with patients <30 years having significantly greater BMD than age groups 30 to 50 (P = .011) and >50 years (P = .032). On multivariable analysis, male sex was independently associated with greater BMD, coronal and sagittal ROC, area, and perimeter, whereas age <30 years was associated with greater BMD and age >50 years with larger area and perimeter.
CONCLUSIONS
Distal radius morphology and BMD vary by sex and age, with men showing greater mean ROC, graft size parameters, and BMD, whereas younger age is associated with higher BMD. For glenoid reconstruction, distal radius allografts derived from younger male donors may provide larger grafts with higher BMD and favorable curvature characteristics to the native glenoid.
CLINICAL RELEVANCE
Distal radius allograft reconstruction has emerged as a viable option for glenoid bone loss in anterior shoulder instability. This study defines age- and sex-based variations in distal radius morphology and bone density to help guide surgeons in selecting grafts with appropriate size, curvature, and bone quality for glenoid augmentation.
P. Boufadel, O. Sogbein, Adam A. Rizk et al.· Arthroscopy: The Journal of...· 0 citations
BACKGROUND
Favorable short-term outcomes after coracoclavicular (CC) ligament reconstruction for acromioclavicular (AC) joint dislocations have been reported; however, data on longer-term outcomes remain limited.
PURPOSE
To evaluate clinical and radiographic outcomes after open and arthroscopic CC ligament reconstruction procedures for AC joint dislocations at a minimum 5-year follow-up.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A systematic review of the PubMed, Embase, and Web of Science databases was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting outcomes after CC ligament reconstruction for AC joint dislocations with a minimum 5-year follow-up were included. The exclusion criteria included Rockwood type 1 and II injuries, nonoperative management, and non-CC ligament reconstruction techniques. Data collected included study and patient characteristics, surgical approach and reconstruction technique, patient-reported outcomes, satisfaction, return to sport, radiographic findings, complications, and reoperations.
RESULTS
Sixteen studies, including 326 patients (327 shoulders), met the inclusion criteria. The weighted mean age was 37 ± 5.9 years, and 85.3% were men. The weighted mean follow-up was 98 ± 41 months. AC dislocations were acute in 69.2% of cases, involved the dominant arm in 61.5%, and were classified as Rockwood types III, IV, and V in 33%, 16.8%, and 50.2%, respectively. Patients had excellent functional outcome scores irrespective of surgical approach or reconstruction technique, with weighted mean Constant, American Shoulder and Elbow Surgeons, Simple Shoulder Test, Subjective Shoulder Value, and visual analog scale pain scores of 93.1, 93.1, 11.3, 91.6, and 0.6, respectively. Satisfaction and return to preinjury level of sport rates were high, at 93.1% and 87.7%, respectively. Radiographic analysis showed no significant change in CC distance from the initial postoperative period to the final follow-up (P = .354). CC ligament ossification and AC joint arthritic changes were each observed in around 15% of cases. The overall complication, recurrence, and reoperation rates were 11.9%, 5.2%, and 6.1%, respectively. Arthroscopic procedures and suture button fixation utilizing synthetic ligament and suspensory devices were associated with higher rates of recurrence, implant-related complications, and adverse radiographic findings.
CONCLUSION
CC ligament reconstruction results in excellent functional outcomes irrespective of surgical approach or technique, with high patient satisfaction, high return to pre-injury level of sport, and low rates of recurrence and reoperation at a minimum 5-year follow-up.
P. Boufadel, Christopher Jayne, Isaiah Hoffman et al.· American Journal of Sports M...· 0 citations
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