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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 most commonly occurs in young patients with high functional demands who participate in heavy work or contact sports. In 95% of all shoulder dislocations, the humeral head displaces anteriorly with respect to the glenoid. Bony defects resulting from an anterior dislocation may manifest in the form of a bony Bankart lesion and/or a Hill-Sachs lesion. Recurrent instability occurs in 67% of patients with considerable glenoid bone loss who undergo soft-tissue stabilization. In patients with more than 20% to 25% glenoid bone loss, reconstruction via a bony procedure is required. Reconstruction of glenoid bone loss can be achieved via coracoid transfer (Latarjet procedure), iliac crest autograft, distal clavicular autograft, or allograft tissue (fresh glenoid osteochondral allograft, fresh distal tibia osteochondral allograft). Osteochondral distal tibia allograft is a graft option for glenoid reconstruction in patients in whom the Latarjet procedure or bony Bankart repair fails because the curvature and concavity of the lateral aspect of the distal tibia is highly congruent with the arc of glenoid bone. It contains dense weight-bearing corticocancellous bone and has a robust articular chondral surface. The glenohumeral contact pressures and contact areas after glenoid reconstruction with the use of fresh osteochondral distal tibia allograft are similar to those of an intact glenoid. PURPOSE. This video demonstrates the surgical technique for anatomic glenoid reconstruction with the use of fresh osteochondral distal tibia allograft. METHOD. This video demonstrates anatomic glenoid reconstruction with the use of fresh osteochondral distal tibia allograft in a 31-year-old patient with recurrent anterior glenohumeral instability after failed bony Bankart repair, which was performed 1 year ago. The surgical technique is demonstrated in a cadaver laboratory and the patient. The video shows allograft preparation, the surgical approach to the shoulder, and graft placement. CONCLUSION. Fresh distal tibia osteochondral allograft is a treatment option for glenoid reconstruction.

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