Background:Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy.Purpose/Hypothesis:The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study.Results:Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively ( P = .006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery ( P = .002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively ( P < .001).Conclusion:Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes.

中文翻译：

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关节镜解剖胫骨同种异体移植术后肩胛下肌影像学完整性和患者报告的结果


背景： 肩部稳定手术随着时间的推移而发展，关节盂侧的骨增强手术被更频繁地进行。Latarjet 手术改变了肩胛下肌的解剖结构，因为连体肌腱通过劈开/取下将肩胛下肌纤维分开，这具有结构和功能意义。关节镜解剖关节盂重建 （AAGR） 重建了解剖结构。该技术使用 Halifax 门户通过旋转器间隔部署和固定远端胫骨同种异体移植物 （DTA），从而保留肩胛下解剖结构。目的/假设： 目的是分析 AAGR 后肩胛下肌的影像学特性。据推测，术后肩胛下肌结构仍保留。研究设计： 病例系列;证据水平， 4.方法： 进行回顾性评价，包括 2012年11月至 2021年4月期间接受 AAGR 联合 DTA 治疗的连续系列患者，用于治疗创伤性前肩关节不稳定伴关节盂骨丢失。如果患者有后部不稳定、关节盂骨折、术前或术后计算机断层扫描 （CT） 扫描缺失，或仅提供 CT 关节造影，则排除患者。CT 扫描测量的影像学变量包括肩胛下肌体积、肩胛下肌/冈下肌比率和根据 Goutallier 分类的脂肪浸润的估计值。收集术前和术后西安大略省肩关节不稳定指数评分作为本研究的次要结局。结果： 纳入研究 93 例患者，临床随访 2.3 ± 1.5 年 （平均 ± SD）。肩胛下肌体积由术前的 185.91 ± 45.85 mL 增加到术后的 194.1 ± 49.0 mL（P = .006）。 手术后肩胛下肌与冈下肌的比率从 0.96 ± 0.27 显着增加至 1.05 ± 0.30 （P = .002）。所有患者术前和术后 Goutallier 分期均为 0。西安大略省肩关节不稳定评分显示，从术前的 64.8 ± 15.5 改善到术后的 28.2 ± 24.0 （P < .001）。结论： 因创伤性肩关节不稳定伴关节盂骨丢失而接受 AAGR 联合 DTA 的患者肩胛下肌体积保留，无脂肪浸润，同时临床结局有显著改善。