Surgeon variation in glenoid bone reconstruction procedures for shoulder instability

Area of Science:

• Orthopedic surgery
• Shoulder instability
• Bone reconstruction techniques

Background:

• Glenoid bone loss is a significant factor in shoulder instability.
• While the Latarjet procedure is established, alternative bony reconstruction methods using free bone grafts (FBB) have emerged.
• Surgeon adoption and rationale for choosing these alternative techniques remain largely uncharacterized.

Purpose of the Study:

• To investigate surgeon variation in glenoid bone reconstruction procedures for shoulder instability.
• To identify the reasons behind surgeons' choices between Latarjet and FBB techniques.
• To understand current practices regarding bony reconstruction in athletes with glenoid bone loss.

Main Methods:

• A 9-question survey was administered to 160 shoulder surgeons from the PacWest Shoulder and Elbow Society.
• The survey collected data on fellowship training, years in practice, surgical volume, preferred reconstruction methods, and decision-making factors.
• 65 surgeons (41% response rate) completed the survey.

Main Results:

• The open Latarjet procedure was the preferred method for 69% of surgeons, followed by open free bone block (FBB) at 22%.
• Distal tibia allograft (DTA) was the most common graft for FBB procedures (74%).
• Key reasons for Latarjet preference included the sling effect and autologous nature; FBB preference cited less anatomic disruption and lower complication rates.

Conclusions:

• While open Latarjet is dominant, a significant minority (nearly 30%) of surgeons in the western US have adopted FBB techniques, with DTA as a favored graft.
• The study highlights the need for high-quality comparative research to guide evidence-based treatment algorithms for glenoid bone loss.
• Surgeon preference for bony reconstruction varies based on patient factors, such as contact versus noncontact sports.