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Review
. 2022 Apr;14(2):123-134.
doi: 10.1177/17585732211008474. Epub 2021 Apr 17.

A review of bone grafting techniques for glenoid reconstruction

Jeffrey A Zhang  1 , Patrick H Lam  1 , Julia Beretov  1 , George Ac Murrell  1
Affiliations
Review

A review of bone grafting techniques for glenoid reconstruction

Jeffrey A Zhang et al. Shoulder Elbow. 2022 Apr.

Abstract

Background: Traumatic anterior shoulder dislocations can cause bony defects of the anterior glenoid rim and are often associated with recurrent shoulder instability. For large glenoid defects of 20-30% without a mobile bony fragment, glenoid reconstruction with bone grafts is often recommended. This review describes two broad categories of glenoid reconstruction procedures found in literature: coracoid transfers involving the Bristow and Latarjet procedures, and free bone grafting techniques.

Methods: An electronic search of MEDLINE and PubMed was conducted to find original articles that described glenoid reconstruction techniques or modifications to existing techniques.

Results: Coracoid transfers involve the Bristow and Latarjet procedures. Modifications to these procedures such as arthroscopic execution, method of graft attachment and orientation have been described. Free bone grafts have been obtained from the iliac crest, distal tibia, acromion, distal clavicle and femoral condyle.

Conclusion: Both coracoid transfers and free bone grafting procedures are options for reconstructing large bony defects of the anterior glenoid rim and have had similar clinical outcomes. Free bone grafts may offer greater flexibility in graft shaping and choice of graft size depending on the bone stock chosen. Novel developments tend towards minimising invasiveness using arthroscopic approaches and examining alternative non-rigid graft fixation techniques.

Keywords: Shoulder; bone graft; glenoid defect; glenoid reconstruction; recurrent instability.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GACM: Journal of Shoulder and Elbow Surgery: Editorial or governing board. Shoulder and Elbow: Editorial or governing board. Smith & Nephew: Paid consultant and research support. Techniques in Shoulder and Elbow Surgery: Editorial or governing board. All other authors: Nil.

Figures

Figure 1.
Figure 1.
Illustration of coracoid graft variations in common coracoid transfer procedures before fixation to the anterior glenoid defect. (a) The graft for the Bristow procedure using the tip of the coracoid process. (b) The graft for the classic Latarjet procedure. (c) The graft for the congruent-arc Latarjet showing a rotation of the classic Latarjet coracoid process graft to maximise articular surface area of the glenoid after repair.
Figure 2.
Figure 2.
Illustration of the cortical button fixation technique described by Boileau et al. The coracoid process was osteotomised and transferred to the anterior glenoid. The entire glenoid was drilled through to allow passage of a 4-strand suture (dotted blue lines). The anterior button has a pegged outlet to avoid damaging the graft with sutures. A sliding knot (Nice-Knot) is tied at the posterior button (marked with red cross) and sutures were tensioned to assist bone-to-bone compression.
Figure 3.
Figure 3.
Illustration of the buckle-down fixation technique described by Smith et al. Three suture anchors were used for graft fixation. Two anchors were placed at the defect site with an off-site anchor placed superiorly to augment and maintain suture tension in the repair construct. Organisation of suture strands was achieved through using a four hole endobutton.
See this image and copyright information in PMC

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