Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft and Hybrid Fixation

Fig 1. The patient is positioned in the lateral decubitus position with 30° posterior tilt to make the glenoid horizontal. The skin is prepared with chlorhexidine and draped with 2 split shoulder drapes. The arm is placed in a pneumatic positioner and abducted 60° in balanced traction. The skin anatomic landmarks and portal sites are marked on a right shoulder. (AI, anteroinferior portal; AS, anterosuperior portal; H, Halifax [far-medial] portal; P, posterior portal.)

Fig 2. Distal tibial allograft preparation. (A) The dimensions of the graft are marked at the posterolateral corner: 10 mm of width and 20 mm of height with a thickness of 15 mm. (B) The graft is held with 2 clamps while it is sawed. (C) The graft is held with the Graft Prep Tool, and the most superior hole is drilled. (D) With a suture-retrieving device, the suture tail ends of an EndoButton implant are passed through the drilled hole in the graft. (E) The EndoButton is placed on the graft. (F) The graft is thoroughly irrigated.

Fig 3. Graft positioning in a right shoulder with the patient in the lateral decubitus position. (A) With viewing from the anterosuperior portal, the double-bullet drill guide is positioned at the 3-o’clock position of the anterior glenoid rim through the posterior portal at the glenoid’s anterior edge. (B) An exterior view shows that the suture tails from the posterior portal are used to shuttle the construct through the enlarged anteroinferior portal. (C) With viewing from the anterosuperior portal, a 1.8-mm Q-Fix suture anchor is placed in the anteroinferior glenoid rim for capsulolabral tissue repair (Bankart repair) after the graft is fixated. It is important to pay attention to the direction and avoid coalescence with the tunnel. (D) With viewing from the anterosuperior portal, the graft is advanced while tension is maintained before it is positioned flush at the anterior glenoid rim. (A, distal tibial allograft; G, anterior glenoid surface; HH, humeral head.)

Fig 4. A right shoulder is shown with the patient in the semi-lateral position. A 2.8-mm drill and sleeve are used through the glenoid in a posterior-to-anterior fashion in the proximal portion of the graft. Then, the guidewire is passed from the posterior to the far-medial portal through the hole for screw placement.

Fig 5. A right shoulder is shown with the patient in the semi-lateral position with viewing from the anterosuperior portal. After positioning of the guidewire is assessed, a 3.5-mm titanium cannulated screw is placed through the graft and glenoid rim to complete the fixation from the far-medial (Halifax) portal. Full compression should be easily achieved for complete fixation. (A, distal tibial allograft; G, anterior glenoid surface; HH, humeral head.)