Arthroscopic Glenoid Reconstruction for Chronic Anteroinferior Shoulder Instability Using a Tricortical Iliac Crest Bone Graft

INTRODUCTION: . 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: .