Arthroscopic Technique for Bone Augmentation With Suture Button Fixation for Anterior Shoulder Instability

Abstract

Glenoid bone loss remains a significant risk factor for recurrent instability after shoulder dislocation. Several options exist for glenoid bone graft augmentation, including autograft and allograft options. Strengths and weaknesses exist for each. Graft fixation with screws remains a key concern for technical viability requiring a medial portal as well as the risk of graft osteolysis. Suture button suspensory fixation is a new technique recently described for arthroscopic iliac crest bone graft; however, no description exists concerning osteochondral graft fixation. We describe an arthroscopic technique for distal tibial allograft glenoid augmentation with suspensory suture button fixation. The rationale and technical aspects of this procedure are discussed.

Arthroscopic Distal Clavicular Autograft for Congruent Glenoid Reconstruction

“…Promising anatomic and biomechanical results have been reported with the use of osteochondral DCA. 16 , 17 , 18 , 19 However, cartilage degeneration is not rare, mostly in athletes, and, in our experience, the shape of the distal clavicle cartilage is rarely concave. Furthermore, drilling anteriorly, under arthroscopy, is potentially dangerous for neurovascular structures and screw fixation of the bone graft is a known source of complications and revision.…”

The Shoulder Instability: An Overview

“…Their outcomes are comparable. 55,56 Although the Letarjet procedure is an option in older patients with concomitant glenoid defects and rotator cuff problems, there is a higher rate of graft and hardware-related issues and reoperation. 57 The contraindications for the Letarjet procedure are recurrent anterior instability in patients above the age of 50 years, elderly patients with an associated massive irreparable rotator cuff tear, first-time dislocation in the elderly without large glenoid rim fracture, voluntary anterior dislocations, uncontrolled epileptic patients, young patients with superior labral tear from anterior to posterior (SLAP) lesions, prosthetic anterior instability, and posttraumatic inferior dislocation.…”

Latarjet Cerclage: The Metal-Free Fixation

“…9,[22][23][24][25] Even though clinically relevant neurologic injury is not common, fixation with screws also may lead to graft osteolysis, cut out, and symptomatic hardware, as previously mentioned. 26 These problems may require the removal of the screws by an open or arthroscopic approach. 23 In addition, failure of screw fixation may result from fractures through one or both drill holes, overtightening of the screws at the coracoid bone block or even from screw breakage in bone graft resorption or pseudarthrosis.…”