Arthroscopic posterior bone block procedure: a new technique using suture anchor fixation

Abstract

We present a novel all-arthroscopic technique of posterior shoulder stabilization that uses suture anchors for both bone block fixation and capsulolabral repair. The bone graft, introduced inside the glenohumeral joint through a cannula, is fixed with 2 suture anchors. The associated posteroinferior capsulolabral repair places the bone block in an extra-articular position. In this article we present the detailed arthroscopic technique performed in a consecutive series of 15 patients and report the early results. We also report the positioning, healing, and remodeling of the bone block using postoperative 3-dimensional computed tomography. The benefits of this new technique are as follows: (1) it is all arthroscopic, preserving the posterior deltoid and posterior rotator cuff muscles; (2) it is accurate, resulting in appropriate bone block positioning; (3) it is efficient, allowing for consistent bone graft healing; (4) it is anatomic, both restoring the glenoid bone stock and repairing the injured posterior labrum; and (5) it is safe, limiting hardware-related complications and eliminating the risk of injury to vital structures associated with drilling or screw insertion from posterior to anterior. We believe that this technique is advantageous because it does not use screws for fixation and may be safer for the patient.

Fig 1

Drawings showing desired placement of bicortical bone graft on posterior aspect of glenoid and its extra-articular position after reattachment of posterior labrum.

Fig 2

The posterior bone block is delivered inside the glenohumeral joint through a cannula and fixed by 2 suture anchors; the arthroscopic view shows that the graft is lying flush to the articular surface.

Fig 3

Arthroscopic views of a right shoulder (seen from anterior portal) showing posterior Bankart repair with small suture anchors allowing reconstruction of a solid posterior bumper and complete coverage of the bone block, which becomes extra-articular.

Fig 4

Early CT images (at 2 weeks) showing correct bone graft positioning: in the vertical plane, the graft is subequatorial, whereas in the horizontal plane, it is flush or slightly overhanging laterally.

Fig 5

CT images showing bone graft healing and remodeling with time in the same patient. The 3-dimensional CT scan image of the initial posterior bone graft at 1 month of follow-up (left), 3-dimensional CT scan image at 20 months' follow-up (middle), and axial cut image (right) show healing and late remodeling of the bone graft with recreation of a pear-shaped glenoid.