Arthroscopic Bone Graft Procedure Combined With Arthroscopic Subscapularis Augmentation for Recurrent Anterior Instability With Glenoid Bone Defect

Abstract

Glenoid bone loss and capsular deficiency represent critical points of arthroscopic Bankart repair failures. The purpose of this Technical Note is to present an all-arthroscopic bone block procedure associated with arthroscopic subscapularis augmentation for treating glenohumeral instability with glenoid bone loss and anterior capsulolabral deficiency. Two glenoid tunnels are set up from the posterior to the anterior side using a dedicated bone block guide, and 4 buttons are used to fix the graft to the glenoid. The subscapularis tenodesis is performed using a suture tape anchor. This combined arthroscopic technique (bone block associated with arthroscopic subscapularis augmentation) could be a valid and safe alternative to the arthroscopic or open Latarjet procedures.

Arthroscopic anatomic glenoid reconstruction demonstrates its safety with short-term to medium-term results for anteroinferior shoulder instability: a systematic review

“…There were 13 studies that described a technique without results presented 12 13 28–38. There were four studies that described a technique as well as presented clinical results 23–25 27.…”

“…Eight techniques used beach chair position,13 23 29 33 36 38 40 and 10 used the lateral decubitus position 24 25 27 28 30–32 34 35 37. Thirty-eight of 237 patients (16.0%) were treated in the beach chair position,23 26 while 199 of 237 (84.0%) patients were treated in the lateral decubitus position 15 19–21 24 25 27.…”

“…The most commonly used portals were the standard posterior, anterior superior and anterior inferior portals. Twelve techniques avoid the subscapularis,12 13 25 27 30–34 36 38 40 while six perform some types of muscle belly or tendon split 23 24 28 29 35 39. One technique offers two methods to pass the graft—a suture method that avoids the subscapularis, and a K-wire method that requires subscapularis split 37.…”

“…Autograft was used in 13 techniques13 23–25 28–30 33–35 37 38 and allograft was used in 6 27 31 32 36 39 40. One-hundred forty-three of 237 patients (60.3%) were treated with autograft15 20 21 23–26 and 94 of 237 (39.5%) were treated with allograft 19.…”

“…One-hundred forty-three of 237 patients (60.3%) were treated with autograft15 20 21 23–26 and 94 of 237 (39.5%) were treated with allograft 19. The most common autograft was iliac crest, used in 11 techniques,12 13 23–25 28–30 34 35 38 including all 143 patients in the autograft group. Distal clavicle autograft was also described in a technique paper with no clinical results presented 37.…”