Arthroscopic “Bone Block Cerclage” Technique for Posterior Shoulder Instability

Abstract

Many open and arthroscopic techniques have been described to treat posterior glenohumeral instability. Multifactorial features of posterior shoulder instability pathoanatomy and varied patient characteristics have challenged the understanding of this condition and have led to dissimilar results, without a strong consensus for the most adequate technique to treat it. We describe an arthroscopic anatomical metal-free posterior glenoid reconstruction technique, using a tricortical iliac crest allograft with 2 ultra-high strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL) with concomitant posterior capsulolabral complex reconstruction procedure.

Comprehensive management of posterior shoulder instability: diagnosis, indications, and technique for arthroscopic bone block augmentation

“…Currently, treatment strategies are focused on soft tissue repair, with capsulolabral reconstruction to restore the glenoid concavity and the posterior bumper effect, with or without reverse remplissage to address reverse Hill-Sachs lesions, having good clinical results in the absence of glenoid defects (8,9). The presence of traumatic or erosive glenoid bone defects, a dysplastic glenoid rim, and a thin posterior capsule has increased the use of techniques with a bone graft (10,11,12,13,14). The use of opening wedge osteotomies and posterior bone block grafts, even in the absence of a bone defect, has been proposed by several authors to reduce the high failure rate after soft tissue repair (15,16,17).…”

“…The use of opening wedge osteotomies and posterior bone block grafts, even in the absence of a bone defect, has been proposed by several authors to reduce the high failure rate after soft tissue repair (15,16,17). Arthroscopic techniques have gained popularity due to lower morbidity, the possibility to completely visualize the labrum and treat concomitant lesions, the prevention of deltoid deficiency, and advances in available instruments and implants (5,12,18).…”

“…In this review, an update in the clinical and radiographic assessment of recurrent posterior instability, its surgical indications, and an algorithm for its management and treatment are presented, while also describing an arthroscopic bone block technique with anatomic, metalfree fixation, and associated capsulolabral reconstruction for those cases in which it is indicated (12).…”

Arthroscopic Posterior Capsulolabral Reconstruction With Gracilis Allograft

“…Grafting techniques have been described to address bone loss if it is thought to be the root cause of failure. [11][12][13] The pathophysiology of posterior instability is at present incompletely understood and may be multifactorial. The posterior labrum and capsulolabral complex are thought to be the primary stabilizers to unidirectional instability, but other factors may also be at play.…”

Single-Portal Arthroscopic Posterior Shoulder Stabilization

“…9,12 Arthroscopic stabilization allows for small incisions in the glenohumeral joint, faster postoperative recovery, and improved range of motion while approaching success rates of up to 90% in overhead athletes. 13,14 Standard arthroscopic posterior stabilization involves posterior and posterolateral working portals and 1 anterosuperolateral or anterior portal for visualization. 4,15 The recent literature citing other techniques for posterior stabilization has also noted the inclusion of an anterior working portal to access the posterior and inferior quadrants of the glenoid with instruments.…”