Purpose: To report the results of a guided arthroscopic Eden-Hybbinette procedure, using suture button for iliac crest bone graft fixation, in a series of patients with a prior failed Latarjet and persistent glenoid bone loss. Methods: Seven consecutive patients (5 males, 2 females, mean age: 30.7 years [range, 17-47 years]) with recurrent anterior dislocations and glenoid deficiency greater than 20% underwent the all-arthroscopic revision procedure. The iliac crest bone graft and suture-button device (Bone-Link) were shuttled through the rotator interval. Specific drill guides were used and a suture tensioning device allowed bone graft compression. Previous broken screw shafts (3 patients) were left in situ. Graft placement and healing was assessed postoperatively with computed tomography imaging. Results: No neurologic injury or hardware problems occurred, and no patient required further surgery. On computed tomography scan, optimal positioning (flush and under the equator) and healing of the bone graft was observed in all patients. At a mean follow-up of 21 months (range, 12-39 months), all but one patient were satisfied and had a stable shoulder; 5 returned to sports. The Constant score increased from 32 to 81 points, and the subjective shoulder value from 31% to 87% (P < .001). The Walch-Duplay and Rowe scores averaged 85.7 (range, 65-100) points and 86.4 (range, 70-100) points, respectively. Conclusion: Recurrence of anterior shoulder instability after a failed Latarjet procedure can be successfully treated by an all-arthroscopic Eden-Hybbinette procedure. Suture-button fixation is reliable and permits optimal positioning and predictable healing of the new bone graft; in addition, it is an appropriate fixation option in the setting of retained broken hardware. This study was performed according to the medical ethical guidelines of Institut Universitaire Locomoteur et du Sport (Approval Ref: Study 2017-05), and a written, informed consent was obtained for all patients. A video of the technique is available upon request to the corresponding author.

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Background: The literature reports recurrent instability after the Latarjet procedure in 1 to 5% of the cases. Therefore, the Eden-Hybbinette technique, which consists of harvesting bone from the iliac crest, has been proposed in case of revision surgery. The objective of this study was to evaluate the clinical and radiographic results of a series of patients treated by an all-arthroscopic Eden-Hybbinette technique with endobutton graft fixation. Methods: Seven patients (5 men, 2 women, mean age 30.7 years (17-47)), with recurrent anterior instability after Latarjet procedure, associated with glenoid bone defect of more than 15% were treated by arthroscopic Eden-Hybbinette technique. The bone graft fixed with an endobutton (Bone-LinkTM) was introduced through the rotator cuff interval. Specific guides and a dynamometer were used to fix the graft by compression on the anterior edge of the glenoid cavity. Previous broken screws were left in place in 3 cases. Patients were clinically followed and the position of the graft and its consolidation were evaluated by CT scan. Results: At mean follow-up of 21 months (12-39), 7/6 patients had a stable shoulder and were satisfied with the result. 5/7 resumed their sporting activity. The mean Constant score increased from 32 to 81 points and the Subjective Shoulder Value from 31 to 87% (p > 0.001). The mean Walch-Duplay and Rowe scores were 85.7 points (65-100) and 86.4 points (70-100) respectively. No neurological complications were reported, and no patients required a new procedure. On the CT scan analysis, the graft did not overhang and was sub-equatorial and healed in all cases. Conclusion: The recurrence of instability after a Latarjet graft can be successfully treated by the Eden-Hybbinette technique under arthroscopy. Endobutton fixation is reliable and optimizes the position and consolidation of the bone graft. In addition, this fixation method is an appropriate option in case of broken hardware left in place.

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