Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction

Background: Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are...

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Main Authors: Benjamin W. Hoyt MD, Cory A. Riccio MD, Lance E. LeClere MD, Kelly G. Kilcoyne MD, Jonathan F. Dickens MD
Format: Article
Language:English
Published: SAGE Publishing 2021-04-01
Series:Video Journal of Sports Medicine
Online Access:https://doi.org/10.1177/26350254211006727
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spelling doaj-5e73c4ce78644a519e54e31bdb3e80ec2021-08-09T07:04:00ZengSAGE PublishingVideo Journal of Sports Medicine2635-02542021-04-01110.1177/26350254211006727Arthroscopic Distal Tibial Allograft for Posterior Glenoid ReconstructionBenjamin W. Hoyt MD0Cory A. Riccio MD1Lance E. LeClere MD2Kelly G. Kilcoyne MD3Jonathan F. Dickens MD4USU-WRNMMC Department of Surgery, Bethesda, Maryland, USAUSU-WRNMMC Department of Surgery, Bethesda, Maryland, USADepartment of Orthopaedic Sports Medicine, United States Naval Academy, Annapolis, Maryland, USAUSU-WRNMMC Department of Surgery, Bethesda, Maryland, USAUSU-WRNMMC Department of Surgery, Bethesda, Maryland, USABackground: Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are described to augment either the version or volume of the glenoid surface including osteotomies, autograft transfers, and allograft tibia transfers. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the posterior glenoid is indicated for revision posterior instability procedures with posterior bone loss and in primary cases of posterior instability with critical bone loss. Technique Description: Arthroscopic posterior glenoid reconstruction with allograft distal tibia and posterior labral repair in the lateral position is presented. This technique uses standard instrument sets and requires no patient repositioning. The preplanned tibial bone block is prepared on a back table either prior to, or concurrently with, arthroscopic procedure. After creation of high posterior portal and standard anterior portal, a sucker-shaver and burr are used to create a perpendicular edge for apposition of the allograft tibia. The bone block is introduced through a longitudinal incision and underdelivered to the prepared surface under the liberated labrum. The articular surface of the graft and glenoid are aligned and cannulated screws are used to compress the bone block against the native glenoid. The posterior labral tissue is then mobilized over the graft and repaired to the native glenoid. Results: Arthroscopic distal tibial allograft augmentation for posterior bone loss restored stability and function in a small cohort of patients. Patients reported improved stability in the immediate postoperative course, with restoration of motion by 2 months. Push-ups, pull-ups, and return to full active duty without restrictions is allowed at 6 months postoperatively. Imaging at 3 months postoperatively has shown excellent graft healing. Discussion: The benefits of allograft tibia augmentation for posterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive approach. When performed arthroscopically, this technique permits concurrent posterior labral repair and anatomic reconstruction.https://doi.org/10.1177/26350254211006727
collection DOAJ
language English
format Article
sources DOAJ
author Benjamin W. Hoyt MD
Cory A. Riccio MD
Lance E. LeClere MD
Kelly G. Kilcoyne MD
Jonathan F. Dickens MD
spellingShingle Benjamin W. Hoyt MD
Cory A. Riccio MD
Lance E. LeClere MD
Kelly G. Kilcoyne MD
Jonathan F. Dickens MD
Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction
Video Journal of Sports Medicine
author_facet Benjamin W. Hoyt MD
Cory A. Riccio MD
Lance E. LeClere MD
Kelly G. Kilcoyne MD
Jonathan F. Dickens MD
author_sort Benjamin W. Hoyt MD
title Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction
title_short Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction
title_full Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction
title_fullStr Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction
title_full_unstemmed Arthroscopic Distal Tibial Allograft for Posterior Glenoid Reconstruction
title_sort arthroscopic distal tibial allograft for posterior glenoid reconstruction
publisher SAGE Publishing
series Video Journal of Sports Medicine
issn 2635-0254
publishDate 2021-04-01
description Background: Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are described to augment either the version or volume of the glenoid surface including osteotomies, autograft transfers, and allograft tibia transfers. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the posterior glenoid is indicated for revision posterior instability procedures with posterior bone loss and in primary cases of posterior instability with critical bone loss. Technique Description: Arthroscopic posterior glenoid reconstruction with allograft distal tibia and posterior labral repair in the lateral position is presented. This technique uses standard instrument sets and requires no patient repositioning. The preplanned tibial bone block is prepared on a back table either prior to, or concurrently with, arthroscopic procedure. After creation of high posterior portal and standard anterior portal, a sucker-shaver and burr are used to create a perpendicular edge for apposition of the allograft tibia. The bone block is introduced through a longitudinal incision and underdelivered to the prepared surface under the liberated labrum. The articular surface of the graft and glenoid are aligned and cannulated screws are used to compress the bone block against the native glenoid. The posterior labral tissue is then mobilized over the graft and repaired to the native glenoid. Results: Arthroscopic distal tibial allograft augmentation for posterior bone loss restored stability and function in a small cohort of patients. Patients reported improved stability in the immediate postoperative course, with restoration of motion by 2 months. Push-ups, pull-ups, and return to full active duty without restrictions is allowed at 6 months postoperatively. Imaging at 3 months postoperatively has shown excellent graft healing. Discussion: The benefits of allograft tibia augmentation for posterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive approach. When performed arthroscopically, this technique permits concurrent posterior labral repair and anatomic reconstruction.
url https://doi.org/10.1177/26350254211006727
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