Hoyt Benjamin W, Riccio Cory A, LeClere Lance E, Kilcoyne Kelly G, Dickens Jonathan F
USU-WRNMMC Department of Surgery, Bethesda, Maryland, USA.
Department of Orthopaedic Sports Medicine, United States Naval Academy, Annapolis, Maryland, USA.
Video J Sports Med. 2021 Jul 1;1(4):26350254211006727. doi: 10.1177/26350254211006727. eCollection 2021 Jul-Aug.
Posterior glenoid bone loss occurs in more than two-thirds of patients with posterior glenohumeral instability, with 14% to 22% having greater than subcritical bone loss (13.5%), a marker for potential need for bony augmentation versus soft tissue-only procedures. Several techniques are described to augment either the version or volume of the glenoid surface including osteotomies, autograft transfers, and allograft tibia transfers.
Arthroscopic-assisted allograft distal tibia bone block augmentation to the posterior glenoid is indicated for revision posterior instability procedures with posterior bone loss and in primary cases of posterior instability with critical bone loss.
Arthroscopic posterior glenoid reconstruction with allograft distal tibia and posterior labral repair in the lateral position is presented. This technique uses standard instrument sets and requires no patient repositioning. The preplanned tibial bone block is prepared on a back table either prior to, or concurrently with, arthroscopic procedure. After creation of high posterior portal and standard anterior portal, a sucker-shaver and burr are used to create a perpendicular edge for apposition of the allograft tibia. The bone block is introduced through a longitudinal incision and underdelivered to the prepared surface under the liberated labrum. The articular surface of the graft and glenoid are aligned and cannulated screws are used to compress the bone block against the native glenoid. The posterior labral tissue is then mobilized over the graft and repaired to the native glenoid.
Arthroscopic distal tibial allograft augmentation for posterior bone loss restored stability and function in a small cohort of patients. Patients reported improved stability in the immediate postoperative course, with restoration of motion by 2 months. Push-ups, pull-ups, and return to full active duty without restrictions is allowed at 6 months postoperatively. Imaging at 3 months postoperatively has shown excellent graft healing.
The benefits of allograft tibia augmentation for posterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive approach. When performed arthroscopically, this technique permits concurrent posterior labral repair and anatomic reconstruction.
三分之二以上的后盂肱关节不稳患者存在肩胛盂后缘骨质缺损，其中14%至22%的患者骨质缺损超过临界值（13.5%），这是可能需要进行骨质增强而非单纯软组织手术的一个指标。描述了几种增加肩胛盂表面形态或容积的技术，包括截骨术、自体骨移植和异体胫骨移植。
关节镜辅助下异体胫骨远端骨块增强肩胛盂后缘适用于伴有后缘骨质缺损的后不稳翻修手术以及伴有临界骨质缺损的原发性后不稳病例。
介绍了在侧卧位下使用异体胫骨远端进行关节镜下肩胛盂后缘重建及后盂唇修复。该技术使用标准器械套装，无需重新摆放患者体位。预先规划好的胫骨骨块可在关节镜手术前或同时在器械台上制备。建立高位后入路和标准前入路后，使用吸引刨削器和磨钻为异体胫骨的贴合创建一个垂直边缘。骨块通过纵向切口引入，并在游离盂唇下方递送至准备好的表面。将移植物和肩胛盂的关节面对齐，使用空心螺钉将骨块压向自体肩胛盂。然后将后盂唇组织游离至移植物上方并修复至自体肩胛盂。
关节镜下异体胫骨移植增强治疗后缘骨质缺损在一小群患者中恢复了稳定性和功能。患者报告术后即刻稳定性改善，2个月时恢复活动度。术后6个月允许进行俯卧撑、引体向上，且可 unrestricted 恢复全负荷活动。术后3个月的影像学检查显示移植物愈合良好。
异体胫骨增强治疗伴有肩胛盂骨质缺损的后不稳的益处包括恢复包括关节软骨在内的解剖学关节面、无供区并发症以及微创方法。当通过关节镜进行时，该技术允许同时进行后盂唇修复和解剖重建。
