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Anatomical Glenoid Reconstruction with Fresh Osteochondral Distal Tibia Allograft: Surgical Technique

February 10, 2018

Contributors: Lorena Bejarano-Pineda, MD; Ken Kadowaki, MD; William Henry Marquez, MD; Francisco Javier Monsalve, MD; Ken Morris Kadowaki, MD; Alvaro Vanegas-Gomez, MD; Alvaro Vanegas-Gomez, MD

INTRODUCTION. Shoulder instability currently affects 2% of the general population. Shoulder instability occurs most commonly in young patients with high functional demands in heavy work or contact sports. In 95% of all shoulder dislocations the humeral head displaces anteriorly in respect to the glenoid. Bony defects can occur as result of anterior dislocation either in the form of bony Bankart lesion and/or a Hill-Sachs lesion. Recurrent instability occurs 67% of the time after soft tissue stabilization when significant glenoid bone loss is present. In cases where there is more than 20%-25% glenoid bone loss, reconstruction with a bony procedure is required. Reconstruction of the glenoid bone loss can be done with coracoid transfer (Latarjet), iliac crest autograft, distal clavicular autograft, or allograft tissue (fresh glenoid osteochondral allograft, fresh distal tibia osteochondral allograft). In case of failed Latarjet procedure or failed bony Bankart repair one potential graft option for glenoid reconstruction is a osteochondral distal tibia allograft because the curvature and concavity of the lateral aspect of the distal tibia to be highly congruent with the arc of glenoid bone. It contains dense weight-bearing corticocancellous bone as well as robust articular chondral surface. The glenohumeral contact pressures and contact areas after glenoid reconstruction with the fresh osteochondral distal tibia allograft are similar to those of the intact glenoid.

PURPOSE. To show the operative technique of anatomical glenoid reconstruction with fresh osteochondral distal tibia allograft.

METHOD. This video presents a technique to anatomical glenoid reconstruction with fresh osteochondral distal tibia allograft in a 31 year old patient with recurrent anterior glenohumeral after failed bony Bankart repair 1 year ago. We demonstrate the surgical technique in cadaver lab and the same procedure in the patient. The video shows the allograft preparation, the surgical approach to the shoulder, and the graft placement.

CONCLUSION. Fresh distal tibia osteochondral allograft is an option for glenoid reconstruction.

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