Metal-Free Fixation for Free Bone-Block Reconstruction of Chronic Anteroinferior Shoulder Instability

Abstract

Background: Anterior shoulder instability is common and may cause a considerable effect on quality of life. For cases with glenoid bone loss, there is still a controversial discussion regarding the optimal treatment. Most of the recent methods are using metal implants to attach the needed graft to the glenoid with reported disadvantages such as metal impingement, damage to the humeral head, cartilage destruction, and premature arthritis. Indications: (1) Erosion-type defects with significant bone loss (>15%-20%); (2) chronic fragment-type defects if the size of the fragment is not large enough for an anatomical reconstruction; and (3) non-reconstructible, multifragmented acute fragment type of lesions. Technique Description: After placing the patient in a lateral decubitus position and fixing the arm in a traction devise, 3 arthroscopic entries are established: a posterior portal, an anterosuperior portal, and an anteroinferior portal. A harvested tricortical iliac crest bone graft is provided with 2 drilling holes which match the drilling holes through the glenoid. The tapes are then placed from the posterior to the anterior side of the glenoid, and then the graft is passed from the anterior to the posterior side, thus compressing the cancellous side of the bone block onto the glenoid defect. A following interconnection of the sutures creates a continuous loop. The end of the tapes was loaded into a pretied racking hitch knot system, which creates sliding knots between the 2 pair of tapes, whereon the knots can be reduced to the glenoid in a symmetrical fashion. Finally, the reconstruction of the anterosuperior labrum can be done, to cover the bone block with enough soft tissue. Results: First short-term results show radiographic consolidation after 3 months and an increased median glenoid estimated surface area at 12 months. The functional scores showed good outcomes, and there were no serious complications reported. Discussion/Conclusion: The presented arthroscopic reconstruction of the glenoid using a tricortical bone graft and high-strength fiber tapes provides a metal-free technique which results in a high primary stability of the construct and should therefore be considered when treating anterior shoulder instability with significant bone loss.

Arthroscopic Anterior Glenoid Bone Grafting for Shoulder Instability Using an Interconnected Suture Anchor Technique

“…For instance, recently published arthroscopic techniques, with the advantage of metal-free implants like the bone cerclage or button techniques, have been largely based on a posterior tensioning fixation of the bone graft requiring an additional enlarged posterior incision. 13 , 17 , 21 , 23 , 24 This posterior fixation of the bone graft has certain disadvantages and carries the risk of multiple potential problems and complications during surgery. First, an additional posterior approach as well as the need of transglenoidal drilling are surgically demanding and uncommon for many surgeons.…”

Arthroscopic Xenograft With Cerclage Fixation: A Method for Glenoid Bone Loss Reconstruction With Cerclage Fixation Using a Specific Posterior Guide

“…To facilitate the passage of 2 preconfigured FiberTape and TigerTape Cerclage systems 20 , 21 , 22 (Arthrex, Naples, FL), the nitinol wires were replaced with 2 specific loop sutures (FiberLink/TigerLink sutures; Arthrex, Naples, FL)—one with the anterior loop and the other with the posterior loop. After switching the camera back to the posterior portal, the 2 loop-sutures were passed out the joint through the anterosuperior portal, and the anteroinferior 8 mm cannula was replaced with a 15 mm metal cannula more suitable for passing through the xenograft ( Fig 8 ).…”

“…We describe a glenoid reconstruction technique using a preshaped xenograft assembled with metal-free fixation method using 2 high-strength suture tapes. 20 , 21 , 22 The tapes are passed from the posterior to the anterior glenoid rim, throughout the xenograft from the anterior to the posterior part, compressing the posterior face of the graft to the glenoid defect, increasing the stability of the fixation. The glenoid drill holes were performed by a specific posterior guide (Arthrex, Naples, FL).…”

Primary Stability and Bone Contact Loading Evaluation of Suture and Screw based Coracoid Graft Fixation for Anterior Glenoid Bone Loss

“…33,44,59 Suture-based bone block fixation alternatives have been developed to circumvent screw-related hardware and graft complications, including independently suspended suture button (SB) constructs 9,25,49 or an all-suture bone block cerclage (BBC). 24,43 These techniques often allow a posterior drilling approach that facilitates glenoid tunnel placement compared with the anterior-posterior screw-based approach. Suture-based fixations have an extensive history in fracture management 7,17,32,34 and have demonstrated sufficient stability with adequate micromotion to allow for bone healing.…”