Arthroscopic Glenoid Bone Grafting With Soft Fixation for Recurrent Anterior Shoulder Dislocation

Fig 1. Customized allograft fragments. Two 2-mm-wide holes placed ∼15 mm apart are made through each graft along the midline of the surface. One absorbable suture is put through each hole in the glenoid-neck graft, with one as a traction suture and the other as a control suture. Abbreviations: GNG, glenoid-neck graft; GSG, glenoid surface graft.

Fig 2. Release of the capsule labrum. The anterior inferior capsule-labrum complex is released from the glenoid neck (A) and elevated to a plane as high as the glenoid surface (B). Arthroscopic view of the left shoulder in a lateral decubitus position through the anterior superior portal. Abbreviations: C-L, the capsule labrum; G, glenoid; H, humeral head.

Fig 3. Drilling holes for the suture anchors. Three holes located at 7, 8:30, and 10 o’clock positions of the glenoid are first drilled at the posterior edge of the glenoid bone bed. (A) Drilling the hole for the 8:30 o’clock anchor. Arthroscopic view of the lateral shoulder in a lateral decubitus position through the posterior portal. (B) Three created holes. Arthroscopic view of the left shoulder in a lateral decubitus position through the anterior superior portal. Abbreviations: BP, bare point of the glenoid; G, glenoid; H, humeral head.

Fig 4. Placement of suture anchors at the 7 o’clock (A) and 10 o’clock (B) positions. Arthroscopic view of the left shoulder in a lateral decubitus position through the posterior portal. Abbreviations: G, glenoid; H, humeral head.

Fig 5. Illustration of the placement of suture anchors at the 7 o’clock (A) and 10 o’clock (B) positions. Left shoulder. Abbreviations: AS, anterior superior portal; IP, inferior posterior portal.

Fig 6. The glenoid bone-grafting instrument set.

Fig 7. Illustration of the position of the glenoid-neck graft after placement. Posterior view of the left shoulder in a lateral decubitus position. Abbreviations: AS, anterior superior portal; CS, control suture; GNG, glenoid-neck graft; IP, inferior posterior portal; TS, traction suture.

Fig 8. Placement of the glenoid neck graft with the bone-grafting instruments. (A) The graft is released from the bone-grafting core bar. Arthroscopic view of the left shoulder in a lateral decubitus position through the posterior portal. (B) The graft is placed at the anterior side of the glenoid neck. Arthroscopic view of the left shoulder in a lateral decubitus position through the anterior superior portal. Abbreviations: CS, control suture; G, glenoid; GNG, glenoid-neck graft; H, humeral head; TS, traction suture.

Fig 9. Illustration of placement of the glenoid surface graft. Posterior view of the left shoulder in a lateral decubitus position. The suture from the 7 o’clock anchor is put through the distal hole of the graft from the underside to the upper side, and the anterior hole of the bone-grafting trocar. The suture from the 10 o’clock anchor is put through the proximal hole of the graft from the underside to the upper side, and the posterior hole of the trocar. Abbreviations: GNG, glenoid neck graft; GSG, glenoid surface graft.

Fig 10. Illustration of the position of the glenoid-surface graft after placement. Posterior view of the left shoulder in a lateral decubitus position. Abbreviations: AS, anterior superior portal; CS, control suture for the glenoid-neck graft; GNG, glenoid-neck graft; GSG, the glenoid-surface graft; IP, inferior posterior portal; TS, traction suture for the glenoid-neck graft.

Fig 11. Placement of the glenoid-surface graft. (A) Release the glenoid-surface graft from the bone-grafting trocar with the core bar. (B) Placing the glenoid-surface graft to the same level of the glenoid cartilage surface. Arthroscopic view of the left shoulder in a lateral decubitus position through the posterior portal. Abbreviations: G, glenoid; GSG, glenoid-surface graft; H, humeral head.

Fig 12. Illustration of suture fixation of the glenoid-surface graft. Posterior view of left shoulder in lateral decubitus position. Abbreviations: AS, anterior superior portal; CS, control suture of the glenoid neck graft; GNG, glenoid-neck graft; GSG, glenoid-surface graft; IP, inferior posterior portal; TS, traction suture for the glenoid neck graft.