Arthroscopic Anatomic Glenoid Reconstruction in Lateral Decubitus Position Using Allograft With Nonrigid Fixation

Abstract

Recurrent shoulder instability is highly associated with glenoid bone loss. Traditionally, bony procedures to address this bone loss have described nonanatomic, coracoid transfer procedures. More recently, anatomic glenoid reconstruction procedures have been described. These were first described as open procedures, and subsequently there have been several arthroscopic procedures described. We provide a description of an arthroscopic anatomic glenoid reconstruction approach with allograft.

Fig 1

(A) The patient is positioned in the lateral decubitus position (left shoulder). (B) Skin markings for standard shoulder arthroscopy portals (left shoulder). (AI, anteroinferior portal; AS, anterosuperior portal; P, posterior portal.)

Fig 2

Free suture for labral control is placed in the anterior, superior labrum (left shoulder, as viewed from posterior portal). (B, biceps; G, glenoid; H, humerus; L, labrum.)

Fig 3

Decortication of the anterior glenoid (left shoulder, as viewed from the anterosuperior portal). (C, capsule; G, glenoid; H, humerus.)

Fig 4

A 20 x 10 x 15-mm graft is prepared from the distal tibia allograft.

Fig 5

Bullet drill guide is positioned posteriorly (left shoulder).

Fig 6

Transglenoid tunnel is drilled (left shoulder, as viewed from the anterosuperior portal). (C, capsule; G, glenoid; H, humerus.)

Fig 7

Monofilament is passed through the transglenoid tunnel (left shoulder, as viewed from the anterosuperior portal). (C, capsule; H, humerus.)

Fig 8

Passing the bone graft through the anteroinferior portal. (left shoulder, as viewed from above). (AI, anteroinferior portal; AS, anterosuperior portal; P, posterior portal.)

Fig 9

A switching stick is passed from the posterior portal to ensure that the graft is not lateralized (left shoulder, as viewed from the anterosuperior portal). (G, glenoid; Gr, graft; H, humerus.)

Fig 10

A tensioner is used to secure the graft with appropriate force of 100 N. (left shoulder, as viewed from above). The white arrow head indicates the tensioner. (AS, anterosuperior portal; P, posterior portal.)