Summary

We present a technique for performing structural posterior bone grafting of the gleaned using the arthroscopic Latarjet equipment.

Abstract

Purpose

of study: Posterior bone block augmentation of the glenoid was first described in 1949 by Fried who performed the procedure in 5 cases. Several authors have subsequently published on the open procedure with good results, particularly in the setting of posterior glenoid bone loss or revision surgery. Recent improvement in arthroscopic techniques and equipment has allowed the fixation of iliac crest bone graft to the posteroinferior glenoid arthroscopically. We present 8 cases of arthroscopic posterior bone block augmentation of the glenoid for posterior instability.

Description of methods: Surgery is performed in the lateral position using the Arthrex glenohumeral distraction tower. Arthroscopy is performed on the shoulder allowing assessment of the joint and any associated pathology. The posterior inferior labrum is mobilised, and a radial capsular split is formed at the desired level on the glenoid. Iliac crest bone graft is harvested and mounted to the Arthroscopic Latarjet holding cannula (DePuy Mitek). This graft is introduced though a posterior skin incision and passed through infraspinatus and the capsular split. The graft is positioned on the glenoid and secured with two guide wires. The graft and glenoid are then drilled and fixed with cannulated screws. Finally, the labrum and capsule is repaired over the graft using anchors.

Summary of results: We have performed arthroscopic posterior bone blocks in 9 shoulders (8 patients). To date there has been one voluntary posterior subluxation (at 14 weeks post operatively), no significant graft resorption, no dislocation and no problems with postoperative stiffness.

Conclusion

We believe arthroscopic bone block augmentation of the glenoid is a useful technique in the management of posterior instability.