Bone augmentation procedures are recommended for a significant bone loss in both primary and revision situations. While the Lanterje procedure has demonstrated good long-term results, there are concerns with the non-atomic nature of this procedure. In other autograft options, such as an iliac crest bone, there is a risk of donor cytomorbidity. In contrast, distal tibial autografts have the ability to restore the granulated articular arc in an anatomic fashion with a congruent curvature similar to the native granuloid. In addition, the distal tibia, which consists of dense corticocancellous bone, can improve fixation. Therefore, this technique has a possibility of anatomic reconstruction without donor cytomorbidity. Distal tibial autograft reconstruction has been reported in both open and ultrascopic techniques using screw fixation. Recently, double suture-button fixation, which facilitates graft delivery and fixation, has been proposed as an alternative to screw fixation. The purpose of this study was to prospectively evaluate the clinical and anatomic outcomes utilizing a novel double suture-button fixation system. Here, inclusion and exclusion criteria are shown. The burn cut region is mobilized and, at the 4-30 position, a traction suture is placed and retrieved. The granule neck is prepared to a flat bleeding surface. The DTA is prepared, two 2.8 mm drill holes are then drilled and the suture-button constructor are fed through each drill hole. Parallel tunnels are made with a 2.8 mm drill utilizing the double barrel granule drill sleeves. Two or three suture anchors are placed along the native granule rim to repair the anterior labrum over the DTA before passing the graft. Looped passing wires are then fed through the outer granule drill sleeves. The anterior inferior cannula is then used to shuttle the button suture using looped passing wires. The graft is then shuttled inter-articularly using a grasper to prevent malrotation. A tension meter is used to tighten the knots to 15 N, and the graft position is adjusted to the granule face. The labrum is then reattached to the native granule rim. Patients followed a rehabilitation program shown here. WOSI and ASES were our primary outcomes. In addition, complications and recurrence rate were also assessed. Post-operative CT imaging was obtained at 6 months. 29 patients were included. The mean bone loss was 21.9%, with 22 of tracheal sacs lesioned. All procedures were completed without significant intraoperative complications or a conversion to an open approach. At the mean follow-up of 10 months, no patient had a recurrent dislocation. At the mean follow-up of 10 months, the mean WOSI and ASES scores at the last follow-up were 82.4 and 94.8 respectively. CT scans were available for 19 of 29 patients. 89% patients had healed grafts. One patient demonstrated no evidence of healing, and one patient had partial healing but with significant graft desorption. There are currently no peer-reviewed studies specifically reporting on the outcome of the DTEA with double suture button fixation. Looking at available studies mostly conducted with the RATA-J procedure, suture button fixation does not seem to be inferior to screw fixation. Our result seems to be as good as these studies and suggests suture button fixation will be applicable for distal tibial graft technique as well. Interestingly, despite its non-vascular allograft nature, our study demonstrated a healing rate of 89% of the distal tibial allograft. However, two patients had unsatisfactory CT scans at six months. Upon case review, we could not determine any significant factors which lead to healing failure. In conclusion, arthroscopic DTEA utilizing double suture button fixation is a bearable technique for the reconstruction of granoid bone loss. Thank you to our friends in Canada for that paper.

bone augmentation procedures

autograft options

distal tibial autografts

double suture-button fixation

clinical and anatomic outcomes