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Journal of Shoulder and Elbow Surgery

Letter to the Editor regarding Moroder et al: “Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial”

Published:April 28, 2021DOI:https://doi.org/10.1016/j.jse.2021.04.022
      We read your article
      • Moroder P.
      • Schulz E.
      • Wierer G.
      • Auffarth A.
      • Habermeyer P.
      • Resch H.
      • et al.
      Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial.
      with interest and found it a useful addition to the literature. We commend you on conducting a randomized controlled trial on this interesting subject area. However, we would like to make the following points;
      • 1.
        Although the study was appropriately powered for the primary outcome of the Western Ontario Instability Index (WOSI),
        • Kirkley A.
        • Griffin S.
        • McLintock H.
        • Ng L.
        The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI).
        we found the study to be significantly underpowered for more serious but infrequent complications such as musculocutaneous nerve injury and recurrent dislocation, which after Laterjet has been reported in systematic review to be around 1.4% and 2.9%, respectively.
        • Griesser M.J.
        • Harris J.D.
        • McCoy B.W.
        • Hussain W.M.
        • Jones M.H.
        • Bishop J.Y.
        • Miniaci A.
        Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review.
        It would, therefore, be inappropriate to draw conclusions regarding the complication profile of the 2 interventions from the sample size in this study.
      • 2.
        The 10% (6/60) loss to follow-up together with the relatively small sample size (as mentioned in point 1), further underpowers the study and affects the robustness of the conclusions you have made.
      • 3.
        There was a very high incidence of instability in the contralateral shoulder in the study group (46/60 patients). When completing the Western Ontario Shoulder Instability Index (WOSI) for shoulder, it would be natural for a participant to compare it to the contralateral side, particularly for things like range of movement included in the WOSI. Although we understand that excluding those with contralateral shoulder problems would have further reduced your study group, it would be interesting to know what the relative WOSI was in those with a normal contralateral shoulder compared to those with instability.
      • 4.
        How did you define postoperative recurrent instability? You report 3 subluxations, but a major issue with all instability studies is the lack of consensus in how a recurrence is defined or quantified. It would be worth using your expertise to better define these parameters for future research.
      • 5.
        Dr. Resch is the pioneering senior author for the described J-bone iliac bone graft technique,
        • Auffarth A.
        • Schauer J.
        • Matis N.
        • Kofler B.
        • Hitzl W.
        • Resch H.
        The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation.
        which appears technically demanding and likely to have a significant learning curve. This raises the question as to how generalizable these findings might be to the rest of us. Do you think the results are transferable to other methods of iliac crest bone grafting such as with screw or button fixation?
      • 6.
        You had a high rate of graft site problems in the J graft group as expected with iliac crest harvest. Do the authors have experience with allograft and would they consider its use over iliac crest graft?
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      References

        • Auffarth A.
        • Schauer J.
        • Matis N.
        • Kofler B.
        • Hitzl W.
        • Resch H.
        The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation.
        Am J Sports Med. 2008; 36: 638-647https://doi.org/10.1177/0363546507309672
        • Griesser M.J.
        • Harris J.D.
        • McCoy B.W.
        • Hussain W.M.
        • Jones M.H.
        • Bishop J.Y.
        • Miniaci A.
        Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review.
        J Shoulder Elbow Surg. 2013; 22: 286-292https://doi.org/10.1016/j.jse.2012.09.009
        • Kirkley A.
        • Griffin S.
        • McLintock H.
        • Ng L.
        The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI).
        Am J Sports Med. 1998; 26: 764-772
        • Moroder P.
        • Schulz E.
        • Wierer G.
        • Auffarth A.
        • Habermeyer P.
        • Resch H.
        • et al.
        Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial.
        J Shoulder Elbow Surg. 2019; 28: 1298-1307https://doi.org/10.1016/j.jse.2019.03.035

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