Background:The use of a distal tibial allograft (DTA) for reconstruction of a glenoid defect in anterior shoulder instability has grown significantly over the past decade. However, few large-scale clinical studies have investigated the clinical and radiographic outcomes of the DTA procedure.Purpose:To conduct a systematic review and meta-analysis of clinical studies with data on outcomes and complications in patients who underwent the DTA procedure for recurrent anterior shoulder instability with glenoid bone loss.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:A comprehensive search of major bibliographic databases was conducted for articles pertaining to the use of a DTA for the management of anterior shoulder instability with associated glenoid bone loss. Postoperative complications and outcomes were extracted and compiled in a meta-analysis.Results:Of the 8 included studies with 329 total participants, the mean patient age was 28.1 ± 10.8 years, 192 (83.8%) patients were male, and the mean follow-up was 38.4 ± 20.5 months. The overall complication rate was 7.1%, with hardware complications (3.8%) being the most common. Partial graft resorption was observed in 36.5% of the participants. Recurrent subluxation was reported in 1.2% of the participants, and recurrent dislocation prompting a reoperation was noted in 0.3% of the participants. There were significant improvements in clinical outcomes, including American Shoulder and Elbow Surgeons score (40.9-point increase; P < .01), Single Assessment Numeric Evaluation (47.2-point increase; P < .01), Western Ontario Shoulder Instability Index (49.4-point decrease; P < .01), Disabilities of the Arm, Shoulder and Hand (20.0-point decrease; P = .03), and visual analog scale (2.1-point decrease; P = .05). Additionally, postoperative shoulder range of motion significantly increased from baseline values.Conclusion:The DTA procedure was associated with a low complication rate, good clinical outcomes, and improved range of motion among patients with anterior shoulder instability and associated glenoid defects.

中文翻译：

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远端同种异体胫骨移植治疗肩关节前部不稳定伴关节盂骨丢失：系统评价和荟萃分析


背景：在过去的十年中，使用远端胫骨同种异体移植物（DTA）重建肩关节前不稳定的关节盂缺损的情况显着增长。然而，很少有大规模的临床研究调查 DTA 手术的临床和影像学结果。目的：对接受 DTA 手术治疗复发性前房瘤的患者的结果和并发症数据的临床研究进行系统回顾和荟萃分析。肩关节不稳定伴关节盂骨质流失。研究设计：系统回顾和荟萃分析；证据级别，4。方法：对主要书目数据库进行了全面检索，查找有关使用 DTA 治疗肩关节前不稳定伴相关关节盂骨丢失的文章。提取术后并发症和结果并进行荟萃分析。结果：在 8 项纳入研究中，共有 329 名参与者，患者平均年龄为 28.1 ± 10.8 岁，192 名患者（83.8%）为男性，平均随访最长为 38.4 ± 20.5 个月。总体并发症发生率为 7.1%，其中硬件并发症 (3.8%) 最常见。 36.5% 的参与者观察到部分移植物吸收。 1.2% 的参与者报告复发性半脱位，0.3% 的参与者报告复发性脱位导致再次手术。临床结果显着改善，包括美国肩肘外科医生评分（增加 40.9 分；P < .01）、单一评估数值评估（增加 47.2 分；P < .01）、西安大略肩部不稳定性指数（49.4） - 点减少；P < .01)，手臂、肩部和手部残疾（减少 20.0 点；P = .03），以及视觉模拟量表 (2.减少1分； P = .05）。此外，术后肩部活动范围较基线值显着增加。结论：DTA 手术并发症发生率低、临床效果良好，并且改善肩关节前不稳定和相关关节盂缺损患者的活动范围。