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. 2015 Sep 21;4(5):e449-56.
doi: 10.1016/j.eats.2015.04.005. eCollection 2015 Oct.

Arthroscopic Anatomic Glenoid Reconstruction Without Subscapularis Split

Ivan H Wong  1 , Nathan Urquhart  1
Affiliations

Arthroscopic Anatomic Glenoid Reconstruction Without Subscapularis Split

Ivan H Wong et al. Arthrosc Tech. .

Abstract

The role of bone loss from the anterior glenoid in recurrent shoulder instability has been well established. We present a completely arthroscopic technique for reconstructing the anterior glenoid with distal tibial allograft and without a subscapularis split. We perform the arthroscopy in the lateral position. We measure and size an allograft distal tibial graft and place it arthroscopically. We use an inside-out medial portal to introduce the graft into the shoulder, passing it through the rotator interval and above the subscapularis. A double-cannula system is used to pass the graft, which is temporarily fixed with K-wires and held in place with cannulated screws. We then perform a Bankart-like repair of the soft tissues to balance the shoulder and augment our repair. Our technique is not only anatomic in the re-creation of the glenoid surface but also anatomic in the preservation of the coracoid and subscapularis tendon and repair of the capsulolabral complex.

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Figures

Fig 1
Fig 1
Semi-lateral position with pneumatic arm holder.
Fig 2
Fig 2
Frozen distal tibia allograft is used as the donor graft.
Fig 3
Fig 3
Micro sagital saw is used to prepare the graft segment. The posterolateral corner tends to have the best contour.
Fig 4
Fig 4
DePuy Mitek Bristow-Latarjet Instability Shoulder System guide is used to place two guide wires, which are then overdrilled with the cannulated drill.
Fig 5
Fig 5
The grafts are then tapped and top-hat washers placed to dissipate hoop stresses when later tightened.
Fig 6
Fig 6
The double barrel cannula system is then attached to the graft via the top-hat washers.
Fig 7
Fig 7
A switching stick placed in the posterior portal is used to shift the subscapularis inferiorly allowing the graft to be placed without splitting the subscapularis muscle.
Fig 8
Fig 8
Guide wires are placed to temporarily affix the graft in proper position on the glenoid before drilling and placing the cannulated screws.
Fig 9
Fig 9
Allograft in position viewed from the (A) anteriosuperior and (B) posterior portals.
Fig 10
Fig 10
Bankart style capsule/labral reattachment.
Fig 11
Fig 11
Postoperative incisions.
Fig 12
Fig 12
Postoperative computed tomography scan.
See this image and copyright information in PMC

References

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    1. Burkhart S.S., De Beer J.F. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16:677–694. - PubMed
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