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Arthroscopic Glenoid Reconstruction With Iliac Crest Bone Block Transfer in the Beach Chair Position.

ABSTRACT: Large anterior glenoid defects pose significant challenges for shoulder stability. Arthroscopic glenoid reconstruction techniques using distal tibia allograft have been proposed as alternatives to open or arthroscopic Latarjet procedures but can increase operating room costs. Iliac crest bone block autograft is a cost-effective option without concern for the graft being undersized. Previous techniques have described arthroscopic glenoid reconstruction in the lateral position, but the beach chair position provides ease of access to both the iliac crest bone graft harvest and arthroscopic bone transfer, as well as facilitates possible conversion to an open approach if necessary. We present our surgical technique for performing an arthroscopic glenoid reconstruction with iliac crest autograft bone block transfer in the beach chair position.

SUBMITTER: Bradley KE

PROVIDER: S-EPMC8085574 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Arthroscopic Iliac Crest Bone Grafting to the Anterior Glenoid.

Project description:Failed arthroscopic soft-tissue stabilization and anterior glenoid bone loss have been shown to have high failure rates after standard arthroscopic stabilization techniques. For patients with recurrent glenohumeral instability, the Bristow-Latarjet procedure is currently the standard of care. It is predominantly performed through an open deltopectoral approach but has recently been described arthroscopically. Although providing excellent clinical outcomes, the Bristow-Latarjet procedure violates the subscapularis muscle, has a steep learning curve with a high complication rate, and permanently changes the anterior shoulder anatomy, making any future revision surgery more challenging. We describe a technique for arthroscopic anterior glenoid augmentation using iliac crest bone graft that does not violate the subscapularis, by creating a far anterior-medial portal that traverses superior to the subscapularis and lateral to the conjoint tendon. The graft is passed through this portal and secured with rigid fixation. An arthroscopic Bankart capsulolabral repair is then performed, making the graft extra-articular. A remplissage can easily be added as indicated, allowing this procedure to arthroscopically address all 3 major components of structural instability: glenoid bone loss, capsulolabral tearing, and humeral bone loss.

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Arthroscopic Autologous Iliac Crest Bone Grafting for Reconstruction of the Glenoid: A Nonrigid Fixation Technique.

Project description:Massive glenoid bone loss in recurrent anterior instability of the shoulder represents a surgical challenge. Some clinical trials have been published assessing the role of arthroscopic iliac crest bone grafting techniques for the management of recurrent anterior instability with glenoid bone loss. However, bone graft fixation is still controversial. We developed a method for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. This technique is based on the assumption that anatomic restoration of glenoid depth and width is essential to restore stability to the shoulder.

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Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device.

Project description:Recurrent anterior shoulder instability with significant bone loss represents a surgical challenge. Anterior bone block procedures including variations of the Latarjet coracoid transfer have been used in this setting. Bone graft resorption with prominence of the metalwork is a serious concern, whereas the relative contribution of the dynamic sling effect of a Latarjet procedure is still controversial. We describe an arthroscopic technique for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. This technique allows accurate placement of the bone block; fixation with 2 knotless TightRope devices (Arthrex, Naples, FL), avoiding the use of screws; and a final labral repair.

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Arthroscopic pectoralis minor release in the beach chair position.

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Arthroscopic Revision with Autologous Iliac Crest Bone Graft for Failed Anatomic Glenoid Reconstruction Using Distal Tibia Allograft.

Project description:Recurrent instability after anterior shoulder stabilization surgery is not an uncommon complication, with variable rates of recurrences associated with different surgical procedures. The Latarjet procedure continues to be the gold standard in the management of anterior instability with significant glenoid bone loss, although a recent trend toward arthroscopic anatomic glenoid reconstruction (AAGR) with distal tibial allograft has been noted, with excellent short-term results and minimal complication rates. Arthroscopic revision stabilization for failed stabilization procedures is increasingly being performed, although it is technically more challenging than the primary stabilization procedure because of the anatomic rearrangements of the index surgery. In this article, we describe a revision arthroscopic technique for anatomic glenoid reconstruction using iliac crest autograft for a previous failed AAGR procedure secondary to nonunion of the graft. The graft is passed through the Halifax far-medial portal without splitting the subscapularis. Arthroscopic revision in the setting of a failed AAGR procedure is technically easier than after a Latarjet procedure, as the anatomy is relatively undisturbed in the former, facilitating easier identification of anatomic landmarks, accurate graft positioning, and decreased risk of neurovascular injuries. A Bankart capsulolabral repair is performed after graft fixation, making the graft extra-articular and providing additional stability.

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Arthroscopic Iliac Bone Block Augmentation for Glenoid Reconstruction: Transglenoid Fixation Technique Using an All-Suture Anchor.

Project description:Arthroscopic Bankart repair of anterior instability has shown relatively good results, but its effectiveness is unclear in cases wherein there is a bone defect in the glenoid bone. The surgical management of recurrent anterior shoulder instability with severe glenoid bone loss has been challenging until now. Therefore the Latarjet procedure was introduced as an alternative that provided good results in cases of full instability with a bone defect. In cases of recurrent anterior shoulder instability, bone defects are often present within the glenoid. To restore glenohumeral stability, a bone augmentation procedure is required, and the Latarjet procedure to use bony transfer from the coracoid is the most popular technique. However, resorption of the bone graft with metal screw protrusion is a serious concern, whereas the relative contribution of the dynamic sling effect of the Latarjet procedure remains controversial. The Latarjet procedure also destroys the normal kinematics, resulting in side effects such as scapular dyskinesia. Here we introduce an arthroscopic anterior bone block procedure for reconstructing anterior glenoid bone defects using an autologous iliac crest graft. This technique enables precise bone block placement and fixation using one all-suture anchor instead of screw fixation.

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Arthroscopically Assisted Latissimus Dorsi Tendon Transfer in Beach-Chair Position.

Project description:Irreparable rotator cuff tears remain a surgical problem. The open technique of latissimus dorsi (LD) tendon transfer to "replace" the irreparable rotator cuff is already well known. The aim of this article is to present a modified arthroscopically assisted LD tendon transfer technique. This technique was adopted to operate on patients in the beach-chair position with several improvements in tendon harvesting and fixation. It can be divided into 6 steps, and only 1 step-LD muscle and tendon release-is performed open. The advantages of the arthroscopic procedure are sparing of the deltoid muscle, the possibility of repairing the subscapularis tendon, and the ability to visualize structures at risk while performing tendon harvesting (radial nerve) and passing into the subacromial space (axillary nerve). It is performed in a similar manner to standard rotator cuff surgery-the beach-chair position does not need any modification, and no sophisticated equipment for either the open or arthroscopic part of the procedure is necessary. Nevertheless, this is a challenging procedure and should only be attempted after training, as well as extensive practice.

| S-EPMC4680951 | biostudies-literature

Arthroscopic Posterior Glenoid Reconstruction With Distal Clavicle Bone-Block.

Project description:Posterior glenoid bone loss is a potential cause for failure in arthroscopic capsulolabral repair. Although multiple techniques have been described to reconstruct posterior bone defects, they do not reliably yield improved patient outcomes and have high complication rates. We present a technique to reconstruct posterior glenoid bone loss using a distal clavicle autologous bone graft harvested by a mini-open approach and secured arthroscopically with suture buttons. The graft is positioned extra-articularly by repairing the posterior labral complex with a knotless fixation using labral tape.

| S-EPMC10995699 | biostudies-literature

Perceived vs. true glenoid anchor placement: a cadaveric comparison of the beach chair and lateral position.

Project description:PurposeTo explore whether patient position influences a surgeon's ability to accurately judge anchor position on the glenoid.Materials and methodsTwo anchors were inserted into the glenoid of 8 shoulders. Arthroscopic videos were taken from 3 views (posterior beach chair [pBC], posterior lateral decubitus [pLD], and anterosuperolateral decubitus [asLD]). The shoulders were disarticulated to identify "true" anchor position. Seventeen shoulder surgeons reviewed the videos and indicated anchor positions using the "clock face" method. Accuracy was measured within tolerances, ranging from zero (exact), 0.5 (half-hour), 1.0, and 1.5 hours of "true" position. Intra- and inter-rater agreement was calculated. Post hoc analyses explored for bias dependent on surgical side.ResultsThe overall accuracy was 34.0%. At tolerances of 0.5, 1.0, and 1.5 hours, accuracy increased to 82.4%, 95.4%, and 98.0%. With a 30° scope, identification of exact position was more accurate in pBC than pLD (odds ratio [OR] = 1.397; P = .029) but not asLD (OR =1.341; P = .197). At a tolerance of 0.5 hour, the 30° scope was more accurate in pBC than both pLD (OR = 1.444; P = .011) and asLD (OR = 1.728; P = .009). In left shoulders, anchors were perceived as more inferior than true position in asLD and pLD. In right shoulders, anchors were perceived as more superior than true position from pBC and pLD. Inter- and intrarater agreement were highest in pBC with a 30° scope (30° scope weighted kappa = 0.783 and 70° scope weighted kappa = 0.853, respectively).ConclusionJudgment of anchor position on video is most accurate in a pBC view. Inter- and intrarater reliability were also highest from a pBC view.

| S-EPMC7846687 | biostudies-literature

Great auricular neuropraxia with beach chair position.

Project description:Shoulder arthroscopy has been shown to be the procedure of choice for many diagnostic and therapeutic interventions. Neuropraxia of the great auricular nerve (GAN) is an uncommon complication of shoulder surgery, with the patient in the beach chair position. We report a case of great auricular neuropraxia associated with direct compression by a horseshoe headrest, used in routine positioning for uncomplicated shoulder surgery. In this case, an arthroscopic approach was taken, under regional anesthesia with sedation in the beach chair position. The GAN, a superficial branch of the cervical plexus, is vulnerable to neuropraxia due to its superficial anatomical location. We recommend that for the procedures of the beach chair position, the auricle be protected and covered with cotton and gauze to avoid direct compression and the position of the head and neck be checked and corrected frequently.

| S-EPMC5529604 | biostudies-other

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