Arthroscopic Glenoid Reconstruction for Chronic Anteroinferior Shoulder Instability Using a Tricortical Iliac Crest Bone Graft

Elisabeth Boehm; Christian Gerhardt; Natascha Kraus; Markus Scheibel

doi:10.2106/JBJS.ST.16.00080

Arthroscopic Glenoid Reconstruction for Chronic Anteroinferior Shoulder Instability Using a Tricortical Iliac Crest Bone Graft

JBJS Essent Surg Tech. 2016 Nov 23;6(4):e39. doi: 10.2106/JBJS.ST.16.00080. eCollection 2016 Dec 28.

Authors

Elisabeth Boehm¹, Christian Gerhardt¹, Natascha Kraus¹, Markus Scheibel¹

Affiliation

¹ Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany.

Abstract

Introduction: Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft is performed to anatomically reconstruct the glenoid and reestablish glenohumeral stability in patients with chronic anteroinferior shoulder instability and substantial osseous defects^1-3.

Step 1 patient positioning: Place the patient in the lateral decubitus position and prepare the arm and ipsilateral iliac crest.

Step 2 diagnostic arthroscopy and portal placement: Perform a diagnostic arthroscopy via the posterior portal and establish an anteroinferior, an anterosuperior, and a deep anteroinferior portal.

Step 3 capsulolabral complex release and scapular neck preparation: Depending on the pathology and morphology of the defect, release the capsulolabral complex from the scapular neck and prepare the glenoid rim and scapular neck with a motorized burr to ensure adequate osseous healing.

Step 4 harvesting and preparation of the iliac crest bone block: Harvest an autologous tricortical iliac crest bone block from the ipsilateral side and contour it appropriately for an anatomic reconstruction of the glenoid.

Step 5 graft insertion and positioning: Enlarge the passage for the graft through the rotator interval, insert the bone block, and position it anatomically at the scapular neck.

Step 6 graft fixation: With the aid of a drill sleeve, temporarily stabilize the graft using Kirschner wires and then definitively attach it to the scapular neck using 2 Bio-Compression screws.

Step 7 capsulolabral repair: Reattach the capsulolabral complex to the original glenoid, inferior and superior to the bone block, using 2 knotless suture anchors to complete the anatomic reconstruction of the glenoid.

Step 8 rehabilitation and postoperative treatment: Immobilize the arm for 6 weeks postoperatively and limit flexion and external rotation during this time period.

Results: Fifteen patients with a mean age of 31.4 years (range, 17 to 49 years) with anteroinferior glenohumeral instability and substantial glenoid defects underwent arthroscopic iliac crest bone-grafting and were prospectively evaluated for an average period of 20.6 months (range, 12 to 65 months)¹².