SPORTS MEDICINE

Arthroscopic Anatomic Glenoid Reconstruction

SPORTS MEDICINE

Arthroscopic Anatomic Glenoid Reconstruction

The Arthroscopic Anatomic Glenoid Reconstruction using Distal Tibial Allograft Technique is a reconstruction method that assists in the recreation of the glenoid surface and aids in the preservation of the coracoid and subscapularis tendon and repair of the capsulolabral complex. It also addresses bone loss issues that can lead to repair failures that other soft tissue treatments may not address.

Adding this technique to your surgical arsenal will allow you to offer a broader range of customized treatment options to your shoulder instability patients.

arthroscopic glenoid

Clinical Advantages

The Arthroscopic Glenoid Reconstruction technique has some distinct advantages over traditional shoulder instability treatments. Including:

  • Preservation of anatomy (Coracoid, Subscapularis, Pectoralis Minor)
  • Less technical and more efficient than traditional Latarjet
  • Smooth cartilage which is less abrasive and better contour
  • Spares the capsule and labrum
  • Easier conversion if a larger than expected bone loss is found

Arthroscopic Glenoid Reconstruction Video

Simplified Arthroscopic Glenoid Reconstruction Surgical Technique and Rationale with Dr. Ivan Wong - Dr. Ivan Wong describes how to treat recurrent shoulder instability with a simplified arthroscopic technique using DePuy Synthes’ LATARJET EXPERIENCE System with distal tibial allograft.

Surgical Technique Steps

Position Patient and Mark Portals

Preferred positioning is in the 30° semi‑lateral position so the glenoid is parallel to the floor. The patient’s arm is then placed in an arm holder and abducted to 60 degrees in balanced suspension.

The arthroscopic portals are then located (Posterior, Anterosuperior, Anteroinferior & the Medial Portal).

  1. Posterior
  2. Anteroinferior
  3. Anterosuperior
  4. Medial Portal (Halifax Portal)

Position Patient and Mark Portals

Perform Diagnostic arthroscopy

A standard diagnostic arthroscopy is performed. A biceps tenotomy is recommended in the presence of preexisting biceps pathology.

Perform Diagnostic arthroscopy

Open the Rotator Interval

Use VAPR™ TRIPOLAR Electrode & FMS™ Shavers to release the rotator interval. The anterosuperior portions of the subscapularis are fully visualised by this release.

Through the anteroinferior portal, a labral elevator is used to mobilize the labrum. This will help to assess the bone loss.

The arthroscope is then shifted to the anterosuperior portal and a cannula is placed in the posterior portal to serve as an outflow to maintain a low intra‑articular portal pressure.

Open the Rotator Interval

Glenoid Preparation

A traction suture is placed around the labrum to assist with mobilization.

At this point the anterior glenoid is completely cleared of tissue using the VAPR™ TRIPOLAR Electrode.

The anterior glenoid is then rasped and decorticated using a burr to provide a bleeding surface for promoted healing.

Glenoid Preparation 1Glenoid Preparation 2

Determine the Glenoid Bone Loss

We determine the appropriate size of the graft based on dimension of the glenoid. A calibrated probe can be used as a reference.

The bare spot can be used as the reference to the center of the native glenoid to determine bone loss.

Determine the Glenoid Bone Loss

Distal Tibial Allograft (DTA) Preparation

A Distal Tibial Allograft (Parametrics) is used for the reconstruction. Usually, the tibia of the same side as the shoulder is used.

Size and mark the distal tibia based on the intraoperative measurements.

Use the posterolateral corner because it best replicates the contour of the native glenoid and provides 3 cortical surfaces for better strength and screw fixation.

Use a micro‑sagittal saw to cut the distal tibia to the appropriate dimensions.

Tips:

  • The dimensions are generally 10 to 15 mm in anteroposterior width and 25 mm in inferior-to-superior height. The graft thickness tends to be 15 mm.
  • Trapezoid shape to increase medial side of the graft for better contact on the anterior glenoid

Distal Tibial Allograft (DTA) Preparation

Distal Tibial Allograft Screw Preparation and Top Hat Insertion

Introduce K‑wires in Alpha and Beta holes through the Inline Drill Guide (288200). Check the position of both K‑wires. If they are not located correctly, replace them one by one.

Distal Tibial Allograft (DTA) Preparation 1

The offset pin is used to stabilize graft while drilling and provide a 7mm offset.  Drill the Alpha hole through the Distal Tibia Graft, over the K‑wire, using the Step Drill for a surgery with Top Hat.

Tip: Place a gauze under the graft when drilling

Distal Tibial Allograft (DTA) Preparation 2

Remove the drill from the Alpha hole, which will remove the K‑wire. Drill the Beta hole over the K‑wire in the same manner.

Distal Tibial Allograft (DTA) Preparation 3

Tap the hole with the Top Hat tap then implant Top Hats in the Alpha and Beta holes using the combo screwdriver.

Distal Tibial Allograft (DTA) Preparation 4

The clear double‑barrel cannula is then attached to the graft inserting the two 3.5mm screws into the Alpha and Beta holes and tightening until sufficient stability is felt.

Distal Tibial Allograft (DTA) Preparation 5

Create the Medial Portal (Halifax Portal)

The medial portal is then created using an inside‑out technique.

The switching stick in the posterior portal is advanced parallel to the glenoid, superior to the subscapularis, and as high as possible toward the humeral head (this ensures reduced risk to the neurovascular structures).

The switching stick is then advanced through the deltoid, and a skin incision is made over the switching stick. A slotted cannula is placed through this portal, followed by a large channeler, to bluntly dilate the medial portal. This allows for easier passage of the DTA at later stages.

Create the Medial Portal (Halifax Portal)

Graft Insertion

During insertion of the graft retract the subscapularis inferiorly using a switching stick from the posterior cannula as opposed to performing a subscapularis split.

Two slotted cannulas (214136) can be used to help prevent soft tissue from being dragged into the shoulder when passing the graft from the outside.

By use of the double‑barrel cannula, the graft is introduced through the medial portal, lateral to the conjoined tendon, and superior to the subscapularis and directly onto the anterior glenoid rim.

Note: Care is taken to view the positioning of the graft through all the portals to ensure accuracy.

Graft Insertion

Graft Positioning

Use the switching stick in the posterior portal that was used to retract the subscapularis inferiorly to manipulate and position the graft, keeping it level with the glenoid face.

Two K‑Wires are inserted through the 3.5mm Screws located in the purple double cannula and penetrated through the skin posteriorly, parallel to the posterior portal.

Tips:

  • Alternate K wires to optimize positioning of the graft
  • Penetration of the articular cartilage should be avoided. The graft height (lateral to medial translation) can be fine-tuned by rotating the double-barrel cannula with 1 K-wire used as fixation on the glenoid.

Graft Positioning

Graft Fixation

The threaded 3.5mm screws are removed from the double cannula. The calibrated Glenoid drill is used to drill and estimate screw length as it perforates the posterior glenoid cortex.

Tips:

  • Kocher forceps are placed on the guidewires to prevent migration during drilling.
  • The screw length is typically 34 to 40 mm.

Load the Cortical Screw over the Glenoid K‑wire and insert into the Alpha hole using the combo screwdriver. The screws should be tightened in alternating fashion, it is during this tightening and compression phase that the top‑hat washers absorb the hoop stress.

Note: It is important to be collinear to prevent stripping of the screw heads.  The subscapularis is then reduced back into the native position in front of the graft using a switching stick from the anteroinferior portal.

Graft Fixation 1

Reattach the Anterior-Inferior Labral Tissue to the Native Glenoid

With the arm repositioned to a 60° abducted position.

Perform a standard Bankart repair of the labrum using GRYPHON® Anchors for additional soft‑tissue support and to make the graft extra‑articular.

Tip: Inferior to superior capsular shift taking traction suture from 3 o clock to 12 o clock

Reattach the Anterior-Inferior Labral Tissue to the Native Glenoid

View Final Construct

View from all portals to ensure a glenoid positioned humeral head while taking it through range of motion and an anterior stress test.

The arthroscopic portals are closed and the arm is placed in a neutral rotation sling.

View Final Construct

Post Operative Protocol

After the arthroscopic glenoid reconstruction procedure, I treat the patients the same as an arthroscopic bankart repair. The patient will be placed in a sling for 6 weeks.

Physiotherapy commences 3‑5 days post op. Range of motion must be achieved before strengthening and exercises which should not reproduce pain.

Return to work generally is associated with reduced hours and modified duties.

Return to sport usually occurs 6‑12 months post‑op. Timelines vary and are dependent on contact vs. non contact sport, as well as level of play.

Products in this Procedure

Latarjet Experience

Bristow Latarjet Experience Shoulder System

Parametrics Medical Distal Tibial Allograft

GRYPHON™ BR Anchor w/ DYNACORD™ Suture

GRYPHON™ BR Anchor w/ DYNACORD™ Suture

GRYPHON™ BR Anchor w/ DYNACORD™ Suture

Related Products

Bristow Latarjet Experience

Bristow Latarjet Experience

GRYPHON™ Suture Anchors

GRYPHON™ Suture Anchors

DYNACORD™ Suture

DYNACORD™ Suture

VERSALOOP™ Soft Anchor

VERSALOOP™ Soft Anchor

Specifications - Ordering Information

Product Code​ Product Description​
0083 Distal Tibia w/Cartilage, Right, Cryo, Non-Irradiated​
0084 Distal Tibia w/Cartilage, Left, Cryo, Non-Irradiated​
OSTD2070RFC Distal Tibia w/Cartilage, Right, Frozen, Irradiated​
OSTD2070LFC Distal Tibia w/Cartilage, Left, Frozen, Irradiated​

 

References

Please refer to the instructions for use for a complete list of indications, contraindications, warnings and precautions.

Parametrics Medical is the exclusive biologics provider for DePuy Synthes Mitek Sports Medicine.

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