Arthroscopic Iliac Crest Bone Grafting to the Anterior Glenoid

Abstract

Failed arthroscopic soft-tissue stabilization and anterior glenoid bone loss have been shown to have high failure rates after standard arthroscopic stabilization techniques. For patients with recurrent glenohumeral instability, the Bristow-Latarjet procedure is currently the standard of care. It is predominantly performed through an open deltopectoral approach but has recently been described arthroscopically. Although providing excellent clinical outcomes, the Bristow-Latarjet procedure violates the subscapularis muscle, has a steep learning curve with a high complication rate, and permanently changes the anterior shoulder anatomy, making any future revision surgery more challenging. We describe a technique for arthroscopic anterior glenoid augmentation using iliac crest bone graft that does not violate the subscapularis, by creating a far anterior-medial portal that traverses superior to the subscapularis and lateral to the conjoint tendon. The graft is passed through this portal and secured with rigid fixation. An arthroscopic Bankart capsulolabral repair is then performed, making the graft extra-articular. A remplissage can easily be added as indicated, allowing this procedure to arthroscopically address all 3 major components of structural instability: glenoid bone loss, capsulolabral tearing, and humeral bone loss.

Fig 1

View of left shoulder through anterior-superior portal in lateral decubitus position. (A) Radiofrequency device peeling back the capsulolabral tissue off the anterior glenoid neck. (B) Microfracture awl creating bone marrow channels in the anterior glenoid neck.

Fig 2

View of left shoulder through anterior-superior portal in lateral decubitus position. (A) Creation of the transpectoral portal in an inside-out manner with a stiff Wissinger rod being passed parallel to the glenoid through the posterolateral portal. (B) Stiff Wissinger rod exiting the skin after creation of the transpectoral portal.

Fig 3

View of left shoulder through anterior-superior portal in lateral decubitus position. (A) Positioning of the iliac crest autograft 1 to 2 mm recessed below the plane of the anterior glenoid. (B) Rigid fixation with the cannulated screw system (Bristow-Latarjet Instability Shoulder System). (C) Standard arthroscopic Bankart repair. (D) Final inspection shows a well-centered humeral head with anterior capsulolabral repair making the graft extra-articular.

Fig 4

Postoperative radiographs of left shoulder. (A) Grashey view showing anatomic position of graft. (B) Axillary view showing anatomic position of bone graft.