Arthroscopic Anatomic Glenoid Reconstruction in the Setting of a Failed Latarjet Using Distal Tibial Allograft

Abstract

Treatment of traumatic anterior glenohumeral dislocation has evolved over the years in terms of surgical approaches and methods of repair. Recurrence of instability following surgical repair remains challenging with conventional methods of open reconstruction. We describe the utilization of arthroscopic anatomic glenoid reconstruction using a distal tibial allograft after a failed Latarjet procedure. Preoperative and operative methodology are described with relevant imaging investigations and a detailed intraoperative arthroscopic technique.

Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft and Hybrid Fixation

“…16 Thus, surgeons have opted for alternative fixation techniques, including isolated suspensory fixation with EndoButtons, 5,6 trying to limit hardware complications and avoid potential revision surgery for hardware removal while maintaining good functional outcomes and obtaining reliable graft fixation, as shown by Boileau et al 17 The use of nonrigid fixation with EndoButtons in the setting of AAGR has also proved safe and effective, mainly in cases of failed Latarjet procedures with previous compression screws. 5,6 In addition, the medial Halifax portal, described with rigid fixation, 2 could be avoided because this technique does not require direct anterior access to the glenoid neck. However, there are increasing concerns regarding graft stability and implant failure with the isolated use of EndoButtons as compared with compression screws.…”

“…2 Later, the same technique was developed with the use of 2 suture-EndoButton devices (Smith & Nephew, Memphis, TN), which is technically less demanding and uses only the routine Bankart repair portals. 5,6 However, isolated EndoButton graft fixation is not a rigid fixation, which potentially could lead to hardware failure and secondary graft displacement. Thus, additional fixation with a compression screw could be beneficial.…”

Arthroscopic Anatomic Glenoid Reconstruction Hardware Removal

“…Alternatives to screw fixation have been studied, including nonrigid fixation with an ENDOBUTTON 10 , 11 and hybrid fixation with compressive screw and suspensory fixation 12 ; however, biomechanical studies demonstrate concerns about fixation strength at the interface of the native glenoid and graft. 13 …”