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 defects1-3. 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.
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 defects1-3. 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.
Authors: Philipp Moroder; Corinna Hirzinger; Stefan Lederer; Nicholas Matis; Wolfgang Hitzl; Mark Tauber; Herbert Resch; Alexander Auffarth Journal: Am J Sports Med Date: 2012-05-10 Impact factor: 6.202
Authors: Jon J P Warner; Thomas J Gill; James D O'hollerhan; Neil Pathare; Peter J Millett Journal: Am J Sports Med Date: 2005-11-22 Impact factor: 6.202