Arthroscopic Iliac Bone Block Augmentation for Glenoid Reconstruction: Transglenoid Fixation Technique Using an All-Suture Anchor

Abstract

Arthroscopic Bankart repair of anterior instability has shown relatively good results, but its effectiveness is unclear in cases wherein there is a bone defect in the glenoid bone. The surgical management of recurrent anterior shoulder instability with severe glenoid bone loss has been challenging until now. Therefore the Latarjet procedure was introduced as an alternative that provided good results in cases of full instability with a bone defect. In cases of recurrent anterior shoulder instability, bone defects are often present within the glenoid. To restore glenohumeral stability, a bone augmentation procedure is required, and the Latarjet procedure to use bony transfer from the coracoid is the most popular technique. However, resorption of the bone graft with metal screw protrusion is a serious concern, whereas the relative contribution of the dynamic sling effect of the Latarjet procedure remains controversial. The Latarjet procedure also destroys the normal kinematics, resulting in side effects such as scapular dyskinesia. Here we introduce an arthroscopic anterior bone block procedure for reconstructing anterior glenoid bone defects using an autologous iliac crest graft. This technique enables precise bone block placement and fixation using one all-suture anchor instead of screw fixation.

Radiological and Histological Analyses of Nonrigid Versus Rigid Fixation for Free Bone Block Procedures in a Rabbit Model of Glenoid Defects

“…8,16,50 Secondary to some of these concerns, some novel surgical techniques, which use a nonrigid fixation approach for graft positioning via suture anchors or suture suspensory systems, have been comprehensively described. 2,22,[56][57][58][59] Given a surge of interest, a recent systematic review reported that nonrigid FBB procedures in clinical scenarios resulted in satisfactory functional outcomes and low recurrence rates of instability, revision rates, and complication rates. 29 Some surgeons also determined that nonrigid FBB procedures using bone grafts could achieve bony union radiologically, resulting in the re-creation of glenoid morphological features.…”

“…5,30,50 In the N-RF group (Figure 4C), the graft was secured via sutures using a nonrigid suspensory fixation technique, modified from clinical procedures using suture anchors. 22,51,[56][57][58][59] Briefly, 2 superficial, transglenoid 0.5-mm minitunnels (blue arrows in Figure 4C) were created at the anterior rim of the glenoid defect (~2:00 and 4:00) using 0.5-mm K-wire, accompanied by 2 deep, parallel minitunnels drilled on the fresh bone bed at the scapular neck using the same method. Next, two 2-0 Ethibond sutures were passed through 2 paired superficial and deep minitunnels using guide wires, respectively, wrapping the superior and inferior one-third portions of the bone graft, with the inferior sutures passing through the graft holes beforehand (white triangles in Figure 4C).…”

Radiological outcomes of iliac crest bone graft augmentation for glenoid bone loss using an open all-suture anchor and washer fixation technique

“…As with Boileau's technique, this necessitates the use of a posterior incision to ensure that the button lies flush against the cortex with no soft tissue interposition. Recently, J o u r n a l P r e -p r o o f Jong et al al published a single all suture anchor fixation technique using ICBG 13 . It relied on only one soft giant knot for fixation with the potentially weaker force applied across the graft and reduced graft rotational stability, and the risk of graft toggling.…”

Autologous osteochondral transplantation method of treatment for recurrent anterior shoulder instability

“…An alternative to Latarjet procedure is offered by arthroscopically performed bone block procedures, including iliac crest autografts or other osteochondral allografts. All-arthroscopic iliac crest autografts augmentation techniques have been reported, including those of Jeong et al [12] using an all-suture anchor, Taverna et al [30] using EndoButton devices, and Scheibel et al [23] using bio-compression screws. These minimally invasive procedures have some potential advantages, including preservation of the subscapularis musculotendinous unit [20], and decreasing the risk of hardware complications because of screw-free graft xation [33].…”