Anatomical glenoid reconstruction via a J-bone graft for recurrent posttraumatic anterior shoulder dislocation.

OBJECTIVE: To reconstruct the anatomical glenoid shape in cases of osseous glenoid rim defects after recurrent posttraumatic anterior shoulder dislocation to restore stability without severely compromising the range of motion. INDICATIONS: Osseous glenoid defects after recurrent posttraumatic anterior shoulder dislocation. Suitable for primary stabilization as well as for revision surgery in cases previously operated on. CONTRAINDICATIONS: Recurrent anterior shoulder dislocations without glenoid rim defects. Hyperlax shoulders with multidirectional instability. Patients over 60 years of age due to compromised bone quality. Teenage patients due to incomplete apophyseal fusion at the iliac crest. SURGICAL TECHNIQUE: The subscapularis tendon and capsule are split. The humeral head is retracted laterally, and the glenoid defect is prepared and abraded with a rasp. A bicortical iliac crest bone block including crest and outer cortex is harvested and molded in a J-shaped manner. To incorporate the graft, a crevice on the glenoid rim is produced using a chisel. The keel is fitted into the preformed crevice with a spiked impactor. The graft's surface is contoured using a high-speed burr.
RESULTS: A total of 47 shoulders were followed-up after an average of 90 months (range 25-152 months). The mean Rowe scores were 94.3 for the affected shoulder and 96.8 for the uninjured shoulder. The Constant scores reached 93.5 and 95 points, respectively. Loss of external rotation was 4.4°. In addition, 24 shoulders were followed-up by computed tomography (CT). There were no recurrences, with the exception of one traumatic graft fracture. Of 19 patients with arthropathy at follow-up, 11 already had arthropathy prior to the procedure.