Biomechanics of Posterior Glenoid Bone Block Procedures for Posterior Instability with and Without Correction of Glenoid Retroversion

Background: Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are described to augment either the version or volume of the glenoid surface including osteotomies, autograft transfers, and allograft tibia transfers. Indications: Arthroscopic-assisted allograft distal tibia bone block augmentation to the posterior glenoid is indicated for revision posterior instability procedures with posterior bone loss and in primary cases of posterior instability with critical bone loss. Technique Description: Arthroscopic posterior glenoid reconstruction with allograft distal tibia and posterior labral repair in the lateral position is presented. This technique uses standard instrument sets and requires no patient repositioning. The preplanned tibial bone block is prepared on a back table either prior to, or concurrently with, arthroscopic procedure. After creation of high posterior portal and standard anterior portal, a sucker-shaver and burr are used to create a perpendicular edge for apposition of the allograft tibia. The bone block is introduced through a longitudinal incision and underdelivered to the prepared surface under the liberated labrum. The articular surface of the graft and glenoid are aligned and cannulated screws are used to compress the bone block against the native glenoid. The posterior labral tissue is then mobilized over the graft and repaired to the native glenoid. Results: Arthroscopic distal tibial allograft augmentation for posterior bone loss restored stability and function in a small cohort of patients. Patients reported improved stability in the immediate postoperative course, with restoration of motion by 2 months. Push-ups, pull-ups, and return to full active duty without restrictions is allowed at 6 months postoperatively. Imaging at 3 months postoperatively has shown excellent graft healing. Discussion: The benefits of allograft tibia augmentation for posterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive approach. When performed arthroscopically, this technique permits concurrent posterior labral repair and anatomic reconstruction.

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One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation

International Journal of Shoulder Surgery ◽

10.4103/0973-6042.161449 ◽

2015 ◽

Vol 9 (3) ◽

pp. 94 ◽

Cited By ~ 2

Author(s):

Riccardo D′Ambrosi ◽

Carlo Perfetti ◽

Guido Garavaglia ◽

Ettore Taverna

Keyword(s):

Bone Block ◽

Posterior Instability ◽

Traumatic Dislocation ◽

Arthroscopically Assisted ◽

One Step ◽

Posterior Bone Block

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Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2019-000413 ◽

2021 ◽

pp. jisakos-2019-000413

Author(s):

Emilio Calvo ◽

Eiji Itoi ◽

Philippe Landreau ◽

Guillermo Arce ◽

Nobuyuki Yamamoto ◽

...

Keyword(s):

Shoulder Instability ◽

Surgical Techniques ◽

Bone Defects ◽

Anterior Shoulder Instability ◽

Bone Block ◽

Posterior Instability ◽

Early Return ◽

Bony Lesions ◽

Glenoid Surface ◽

Posterior Bone Block

Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.

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Posterior Bone Block for Posterior Instability

Techniques in Shoulder & Elbow Surgery ◽

10.1097/01.bte.0000156392.00292.96 ◽

2005 ◽

Vol 6 (1) ◽

pp. 26-35

Author(s):

Christophe Levigne ◽

Jérome Garret ◽

Gilles Walch

Keyword(s):

Bone Block ◽

Posterior Instability ◽

Posterior Bone Block

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Recurrent posterior shoulder instability starting in childhood and adolescence

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0296.r1 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1760-1766

Author(s):

Tristan Langlais ◽

Marie B. Hardy ◽

Vincent Lavoue ◽

Hugo Barret ◽

Adam Wilson ◽

...

Keyword(s):

Return To Sport ◽

Bone Block ◽

Childhood And Adolescence ◽

Posterior Instability ◽

Shoulder Stabilization ◽

Group I ◽

Posterior Shoulder ◽

Age At Surgery ◽

Posterior Bone Block

Aims We aimed to address the question on whether there is a place for shoulder stabilization surgery in patients who had voluntary posterior instability starting in childhood and adolescence, and later becoming involuntary and uncontrollable. Methods Consecutive patients who had an operation for recurrent posterior instability before the age of 18 years were studied retrospectively. All patients had failed conservative treatment for at least six months prior to surgery; and no patients had psychiatric disorders. Two groups were identified and compared: voluntary posterior instability starting in childhood which became uncontrollable and involuntary (group VBI); and involuntary posterior instability (group I). Patients were reviewed and assessed at least two years after surgery by two examiners. Results In all 38 patients (40 shoulders) were included: group I (20 shoulders), with involuntary posterior instability (onset at 14 years of age (SD 2.3), and group VBI (20 shoulders), with initially voluntary posterior instability (onset at 9 years of age (SD 2.6) later becoming involuntary (16 years of age (SD 3.5). Mean age at surgery was 20 years (SD 4.6 years; 12 to 35). A posterior bone block was performed in 18 patients and a posterior capsular shift in 22. The mean follow-up was 7.7 years (2 to 18). Recurrence of posterior instability was seen in nine patients, 30% in group VBI (6/20 shoulders) and 15% in group I (3/20 shoulders) (p > 0.050). At final follow-up, the shoulder's of two patients in each group had been revised. No differences between either group were found for functional outcomes, return to sport, subjective, and radiological results. Conclusion Although achieving stability in patients with so-called voluntary instability, which evolves into an involuntary condition, is difficult, shoulder stabilization may be undertaken with similar outcomes to those patients treated surgically for involuntary instability. Cite this article: Bone Joint J 2020;102-B(12):1760–1766.

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