Arthroscopic Distal Clavicular Autograft for Treating Shoulder Instability With Glenoid Bone Loss

Abstract

Glenoid bone loss is a significant risk factor for failure after arthroscopic shoulder stabilization. Multiple options are available to reconstruct this bone loss, including coracoid transfer, iliac crest bone graft, and osteoarticular allograft. Each technique has strengths and weaknesses. Coracoid grafts are limited to anterior augmentation and, along with iliac crest, do not provide an osteochondral reconstruction. Osteochondral allografts do provide a cartilage source but are challenged by the potential for graft rejection, infection, cost, and availability. We describe the use of a distal clavicular osteochondral autograft for bony augmentation in cases of glenohumeral instability with significant bone loss. This graft has the advantages of being readily available and cost-effective, it provides an autologous osteochondral transplant with minimal donor-site morbidity, and it can be used in both anterior and posterior bone loss cases. The rationale and technical aspects of arthroscopic performance will be discussed. Clinical studies are warranted to determine the outcomes of the use of the distal clavicle as a graft in shoulder instability.

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

“…However these studies are limited by small population groups and limited followup period [67][68][69] . The use of a distal clavicle arthroscopic autograft has also been reported [70] . Several studies have commented on the use of allografts for glenoid reconstructions.…”

Use of a Cutting Instrument for Fresh Osteochondral Distal Tibia Allograft Preparation: Treatment of Glenoid Bone Loss

“…18 Iliac crest and distal clavicle bone grafts have shown successful union and stability in a limited number of patients. 12,14 The DTA reconstruction has yielded promising clinical results as well, and it has been shown to be biomechanically comparable with the gold standard Latarjet procedure, resulting in significantly improved glenohumeral contact areas in 60 of abduction, as well as in the abduction and external rotation position. In addition, DTA reconstruction results in significantly lower glenohumeral peak forces in the abduction and external rotation position.…”

“…Open glenoid bone augmentation procedures such as the Latarjet, iliac crest bone grafting, distal clavicle bone grafting, and distal tibia allograft (DTA) techniques are currently recommended for patients presenting with recurrent shoulder instability. [11][12][13][14] Bone grafting of large anteroinferior glenoid defects significantly increases shoulder stability, and the extent of improvement in stability is correlated with graft height and contour to the glenoid surface. 15 Bone grafting offers an excellent option for glenoid reconstruction, although some bony augmentation procedures result in nonanatomic constructs, leading to a malformed joint.…”

Arthroscopic Iliac Crest Bone Grafting to the Anterior Glenoid

“…Moreover, this graft is expensive, may not be readily available, and has the inherent risks of graft rejection and infection. 12,13 We believe that an all-arthroscopic anterior glenoid bony augmentation procedure provides a promising and versatile option for those patients requiring a bony procedure in a minimally invasive anatomic manner. This procedure provides a safe, precise augmentation for glenoid bone loss while allowing for additional remplissage and arthroscopic Bankart repairs to be performed.…”

“…Other free grafts have been described for glenoid reconstruction, namely the distal clavicle and freshfrozen distal tibia. 12,13 Although the distal clavicle graft provides autologous cartilage, is readily available, and is cost-effective, its contour is not anatomic to the glenoid and can make for a difficult well-contoured fit.…”