Arthroscopic iliac crest bone grafting in recurrent anterior
Bony glenoid defects frequently occur in patients with recurrent anterior shoulder instability, and numerous surgical techniques have been described to restore the pear-shaped anatomy and concavity of the glenoid. In general, free bone block procedures can be differentiated from the coracoid transfer. While the stabilizing effect of the non-anatomic Latarjet procedure is generated by the bone block acting as a mechanic barrier in combination with a sling effect of the conjoined tendons, free bone block procedures aim to restore the glenoid concavity and anatomy of the glenohumeral joint to re-establish stability.

A study was done to evaluate the clinical and radiologic mid- to long-term results of anatomic glenoid reconstruction using an all-arthroscopic, autologous tricortical iliac crest bone-grafting technique in patients with recurrent anterior shoulder instability. The hypothesis was that patients show good clinical results and a stable shoulder joint with an anatomic glenoid configuration after a minimum follow-up period of 5 years.

Fourteen patients were available after a follow-up period of 78.7 months. The SSV averaged 87%, CS 94 points, RS 89 points, WD 87 points, and WOSI 70%. The apprehension sign was positive in two patients (14%). One patient required an arthroscopic capsular plication due to a persisting feeling of instability, while the second patient experienced recurrent dislocations after a trauma, but refused revision surgery. CT imaging showed a significant increase of the glenoid index from preoperative 0.8 ± 0.04 to 1.0 ± 0.11 at the final follow-up.

In conclusion, arthroscopic reconstruction of anteroinferior glenoid defects using an autologous iliac crest bone-grafting technique yields satisfying clinical and radiologic results after a mid- to long-term follow-up period. Postoperative re-dislocation was experienced in one (7.1%) of the patients due to trauma and anatomic reconstruction of the pear-shaped glenoid configuration was observed.