Arthroscopic Parallel Double-Pulley Iliac Crest Bone Graft Fixation for Anterior Glenoid Reconstruction

Abstract

Glenoid bone defect is one major contributor to anterior shoulder instability. Numerous procedures have been developed for anterior glenoid reconstruction, such as the Eden-Hybinette procedure and the Latarjet-Bristow procedure, as well as various techniques for graft fixation, including screw, endobutton, and anchor fixation. However, these methods can be instrumentally and technically complex. This Technical Note introduces a arthroscopic technique using double-row suture anchors and parallel double-pulley to fix iliac crest bone grafts for anterior glenoid reconstruction, which enables convenient and quick fixation of the bone graft without requirement of any specialized instruments or consumables.

Fig 1

(A) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position showing the release of labrum-capsular complex (LCC) adherent to the glenoid (G) neck. (B) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position demonstrating the freshness at the glenoid defect with a burr. (C) Arthroscopic image of a right shoulder viewing from the 5-o'clock portal in the lateral decubitus position showing 2 absorbable suture anchors (red arrows) implanted as internal row anchors.

Fig 2

Image showing the iliac bone graft (IBG) harvested from ipsilateral iliac crest with 2 holes drilled.

Fig 3

(A) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position displaying the iliac bone graft (IBG) introduced into the joint cavity under pulling of the traction cable (red arrow) and pushing of a hemostat (H). (B) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position visualizing the fixation of the IBG to the glenoid (G).

Fig 4

(A) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position showing a double pulley tied by one tail suture of the external anchor and the tail suture of the internal anchor. (B) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position showing 2 parallel double-pulley structures (red arrows).

Fig 5

(A) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position showing the remaining tail sutures of the 2 external-row anchors used to repair the labrum-capsular complex (LCC) and tighten the inferior glenohumeral ligament (IGL). (B) Arthroscopic image of a right shoulder viewing from the anterolateral portal in the lateral decubitus position with additional suture anchor needed to further repair the labrum-capsular complex.