Abstract

PURPOSE:

The aim of this study was to assess clinical outcomes and radiological outcomes after osteochondral allograft reconstruction for glenoid bone loss.

METHODS:

Glenoid bone loss can occur in the setting of recurrent glenohumeral instability and poses a challenge for surgeons. Reconstruction of these defects with allografts has been proposed as an alternative to both arthroscopic stabilization and nonanatomic bony augmentation procedures with autografts. We conducted a systematic review of the literature for studies of any level of evidence that reported clinical or radiological outcomes (or both) after allograft reconstruction for glenoid deficiency in the setting of recurrent shoulder instability. Data collected included study and patient characteristics, surgical technique, outcome scores, range of motion, strength, subjective outcomes, radiological outcomes, and complications. Data from studies with a sample size of at least 5 were pooled in the main analysis. Studies were assessed for the presence of methodological bias.

RESULTS:

Eight studies met the inclusion criteria and were included in the review. Three studies were deemed eligible for pooled analysis. The study group consisted of 70 shoulders with a mean age of 27.7 years (74.6% of participants were men) and a mean follow-up period of 44.5 ± 17.7 (range, 32 to 90) months. The mean final Rowe score was 90.6, representing a mean improvement of 57.5. Only 9.8% of patients complained of persistent or unimproved pain, and 93.4% were satisfied. Bony integration of the allograft was documented in 100% of shoulders. Recurrence of glenohumeral dislocation and overall instability were seen in 2.9% and 7.1% of cases, respectively.

CONCLUSIONS:

The current body of Level IV data suggests that allograft reconstruction for glenoid bone loss provides excellent clinical outcomes, low rates of recurrent instability, and high osseous incorporation rates with no evidence of graft resorption.

LEVEL OF EVIDENCE:

Level IV, systematic review of Level IV studies.

2

Glenohumeral corticosteroid injections in adhesive capsulitis: a systematic search and review.

Abstract

OBJECTIVES:

To assess the literature on outcomes of corticosteroid injections for adhesive capsulitis, and in particular, image-guided corticosteroid injections. TYPE: Systematic search and review LITERATURE SURVEY: The databases used were PubMed (1966-present), Embase (1947-present), Web of Science (1900-present), and the Cochrane Central Register of Controlled Trials. Upon reviewing full text articles of these studies, a total of 25 studies were identified for inclusion. The final yield included 7 prospective studies, 16 randomized trials, and 2 retrospective studies.

This systematic review was formatted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study criteria were limited to clinical trials, prospective studies, and retrospective studies that specifically evaluated intra-articular corticosteroid injections, both alone and in combination with other treatment modalities, for shoulder adhesive capsulitis. We included studies that were not randomized control trials because our review was not a meta-analysis. Data items extracted from each study included: study design, study population, mean patient age, duration of study, duration of symptoms, intervention, single or multiple injections, location of injections, control population, follow up duration, and outcome measurements. A percent change in outcome measures was calculated when corresponding data was available. Risk of bias in individual studies was assessed when appropriate.

All studies involved at least one corticosteroid injection intended for placement in the glenohumeral joint but only eight studies used image-guidance for all injections. Seven of these studies reported statistically significant improvements in ROM at 12 weeks of follow-up or earlier. Ninety-two percent of all studies documented a greater improvement in either visual analog pain scores or range of motion after corticosteroid injections in the first 1-6 weeks as compared with the control or comparison group.

Corticosteroid injections offer rapid pain relief in the short-term (particularly in the first 6 weeks) for adhesive capsulitis. Long-term outcomes seem to be similar to other treatments including placebo. The added benefit of image-guided corticosteroid injections in improving shoulder outcomes needs further assessment.