Arthroscopic Distal Tibial Allograft Augmentation for Posterior Shoulder Instability With Glenoid Bone Loss

Abstract

Glenoid bone loss is commonly associated with recurrent shoulder instability. Failure to recognize and appropriately address it can lead to poor outcomes. Numerous studies have found anterior-inferior glenoid bone loss in the setting of recurrent anterior instability. Though much less common, posterior shoulder instability can be seen in the setting of acute trauma, epilepsy, electrocution, and alcoholism. Heightened awareness has led to recognition in collision athletes as well. Posterior glenoid bone loss must be addressed in a similar fashion to anterior glenoid bone loss to prevent recurrent instability. Open bone augmentation procedures have been described with successful results. In this technical note, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation. In addition, a current review regarding the diagnosis and management of recurrent posterior shoulder instability is provided.

Comparison of Glenohumeral Contact Pressures and Contact Areas After Posterior Glenoid Reconstruction With an Iliac Crest Bone Graft or Distal Tibial Osteochondral Allograft

“…9,16 Specifically, Petrera and colleagues 20 More recently, Gupta and colleagues 9 described the surgical technique for an arthroscopic approach to posterior glenoid augmentation with fresh DTA; however, no clinical outcomes are yet available. Certainly, the benefits of fresh allografts in overall healing are numerous, with an increase in chondrocyte viability when compared with frozen allografts or those preserved in other ways.…”

Application of a new polyester patch in arthroscopic massive rotator cuff repair—a prospective cohort study

“…However, in these difficult cases in which direct repair is impossible, this might be an alternative to palliative treatment, such as d ebridement, synovectomy, biceps tenotomy, tuberoplasty if needed, nonanatomic repair or partial repair, and tendon transfers (such as latissimus dorsi, pectoralis major, teres minor, deltoid, and trapezius transfer). Allografts such as freeze-dried RC allografts, 34,35 fascia lata allograft, 22 and human dermal matrix (GraftJacket; Wright Medical Group, Memphis, TN, USA) 2,4,18,43,49 overall showed good clinical and, if assessed, radiologic outcome. In addition, Bond et al 4 could radiologically assess full incorporation of the GraftJacket in >70% of the patients.…”

Posterior Shoulder Instability

“…Numerous novel techniques have been reported to reconstruct the posterior glenoid, including iliac crest bone block, distal tibial allograft, glenoid allograft, pedunculated acromial graft, and distal clavicular autograft (Figure 6). 1,15,34,38,40,42,43 …”