Arthroscopic anatomic glenoid reconstruction (AAGR) is an emerging surgical technique for shoulder instability. However, a key limitation of AAGR is the occurrence of hardware-related complications that may develop over time due to glenoid remodeling. To address these issues, an updated AAGR technique has been introduced that employs a custom-sized distal tibial allograft (DTA) to more accurately replicate the individual anatomy of patients. This study aims to evaluate and compare the incidence of hardware complications between two generations of the AAGR technique. A retrospective review was conducted involving 144 patients who underwent AAGR surgery using DTA with screws. The cohort was divided into two groups: the Generation One (G1) group, consisting of patients from 2014–2019 (n = 84), and the Generation Two (G2) group, comprising of patients from 2020–2022 (n = 60). Charts were reviewed and analyzed for variables including age at surgery, gender, side of the procedure, date of surgery, pre- and post-operative CT scans, patient-reported outcomes, and functional outcomes. Significance level was set to 0.05. Demographics were similar between groups. In the G2 group, 2.9% of patients experienced hardware complications compared to 10.7% in G1 (p=0.123). No G2 patients underwent revision hardware removal, while 8.3% of G1 patients required revision surgery for hardware removal (p=0.025). DTA graft sizes were larger in the G1 group (p=0.025), however the graft + glenoid anteroposterior (AP) diameter on 1-year post-operative CTs was similar between groups (p=0.400). Both groups saw significant improvement in WOSI scores, strength, and range of motion from pre- to post-operative. All patients demonstrated excellent outcomes following AAGR, with a significantly lower rate of hardware complications observed in the G2 group, where no patients required revision surgery for hardware removal. This reduction is particularly notable given the larger DTA grafts used in the G1 group, yet both groups displayed comparable graft + glenoid anteroposterior (AP) diameters after one year, suggesting that grafts remodel to the native glenoid anatomy effectively. The use of an individualized DTA not only reduces graft resorption and subsequent screw protrusion but also enhances the stability and longevity of the reconstruction. These findings support the adoption of customized graft techniques in AAGR, which may lead to improved patient outcomes and reduced need for follow-up surgeries. Future research should focus on long-term outcomes and the potential benefits of individualized grafting strategies in other orthopedic procedures.
Bartholomeusz et al. (Wed,) studied this question.