Discectomy and fusion demonstrated in a typical and spondylotic cervical spine.
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Arthroscopic Glenoid Reconstruction for Chronic Anteroinferior Shoulder Instability Using a Tricortical Iliac Crest Bone GraftPear shape of the glenoid can be successfully reconstructed with this technique.
Latest Surgical Technique
- Elisabeth Boehm
- Christian Gerhardt , MD
- Natascha Kraus , MD
- Markus Scheibel , MD
- Elisabeth Boehm1,
- Christian Gerhardt, MD1,
- Natascha Kraus, MD1 and
- Markus Scheibel, MD1,a
- 1Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
- ↵aE-mail address for M. Scheibel:
Introduction Arthroscopic glenoid reconstruction using a tricortical iliac crest bone graft is performed to anatomically reconstruct the glenoid and reestablish glenohumeral stability in patients with chronic anteroinferior shoulder instability and substantial osseous defects1-3.
Indications & Contraindications
Step 1: Patient Positioning Place the patient in the lateral decubitus position and prepare the arm and ipsilateral iliac crest.
Step 2: Diagnostic Arthroscopy and Portal Placement Perform a diagnostic arthroscopy via the posterior portal and establish an anteroinferior, an anterosuperior, and a deep anteroinferior portal.
Step 3: Capsulolabral Complex Release and Scapular Neck Preparation Depending on the pathology and morphology of the defect, release the capsulolabral complex from the scapular neck and prepare the glenoid rim and scapular neck with a motorized burr to ensure adequate osseous healing.
Step 4: Harvesting and Preparation of the Iliac Crest Bone Block Harvest an autologous tricortical iliac crest bone block from the ipsilateral side and contour it appropriately for an anatomic reconstruction of the glenoid.
Step 5: Graft Insertion and Positioning Enlarge the passage for the graft through the rotator interval, insert the bone block, and position it anatomically at the scapular neck.
Step 6: Graft Fixation With the aid of a drill sleeve, temporarily stabilize the graft using Kirschner wires and then definitively attach it to the scapular neck using 2 Bio-Compression screws.
Step 7: Capsulolabral Repair Reattach the capsulolabral complex to the original glenoid, inferior and superior to the bone block, using 2 knotless suture anchors to complete the anatomic reconstruction of the glenoid.
Step 8: Rehabilitation and Postoperative Treatment Immobilize the arm for 6 weeks postoperatively and limit flexion and external rotation during this time period.
Results Fifteen patients with a mean age of 31.4 years (range, 17 to 49 years) with anteroinferior glenohumeral instability and substantial glenoid defects …