Posterior Glenoid Augmentation With Extra-articular Iliac Crest Autograft for Recurrent Posterior Shoulder Instability

Abstract

Several techniques have been described for bone block augmentation as a treatment for posterior shoulder instability, including intra-articular distal tibial allograft and extra-articular iliac crest autograft. Although indications are not yet well defined, these bone augmentation procedures are considered in patients with glenoid bone loss, increased glenoid retroversion, previous failed posterior soft-tissue repair, and insufficient posterior capsulolabral tissue. In patients with posterior glenoid bone loss, the senior author (P.J.M.) recommends intra-articular glenoid reconstruction with a fresh distal tibial osteoarticular allograft. In patients with insufficient posterior capsulolabral tissue, the senior author prefers an extra-articular iliac crest autograft to buttress the posterior soft-tissue restraints. This technique guide outlines extra-articular iliac crest autograft treatment for recurrent posterior shoulder instability in patients with insufficient posterior soft tissues due to prior failed surgery. After an open capsulolabral repair is performed using suture anchors, the bone block is placed extra-articularly on the posterior glenoid neck.

Arthroscopic Posterior Labral Repair and Capsular Closure via Single Working Portal for Posterior Shoulder Instability

“…Bony malformations, which most commonly occur in the posteroinferior quadrant, 24 may be corrected with procedures such as augmentation with iliac crest autograft or a bony Bankart bridge technique. 25,26 In conclusion, the presented surgical technique illustrates a feasible arthroscopic approach using a single posterior working portal with the patient in the beach-chair position for the treatment of PSI.…”

Open Stabilization Procedures of the Shoulder in the Athlete: Indications, Techniques, and Outcomes

“…This procedure can be performed either open or arthroscopically and achieves increased stability by increasing the glenoid surface area. [92][93][94][95][96][97][98] Via either modality, bone graft for the treatment of anterior shoulder instability requires fixation of the graft flush to the anterior glenoid rim on the anterior glenoid neck; 99 for posterior shoulder instability, the graft must either flush or 1mm lateral to the native glenoid on the posterior glenoid neck. 94 Numerous autografts and allografts have been studied 94,[99][100][101] but distal tibial allograft specifically has been demonstrated to recreate an anatomic reconstruction of the glenoid cavity to reduce early symptomatic glenohumeral arthritis.…”

Arthroscopic Posterior Capsulolabral Reconstruction With Gracilis Allograft

“…Grafting techniques have been described to address bone loss if it is thought to be the root cause of failure. [11][12][13] The pathophysiology of posterior instability is at present incompletely understood and may be multifactorial. The posterior labrum and capsulolabral complex are thought to be the primary stabilizers to unidirectional instability, but other factors may also be at play.…”