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Distal Tibia Allograft for Management of Anterior Glenoid Bone Loss

February 01, 2014

Contributors: Sanjeev Bhatia, MD; Peter Nissen Chalmers, MD; Nikhil N Verma, MD; Brian J Cole, MD, MBA, FAAOS; Anthony A Romeo, MD, FAAOS; CAPT (Ret) Matthew T. Provencher, MD MC USNR; Rachel M Frank, MD; Rachel M Frank, MD

Recurrent anterior shoulder instability remains a growing problem in young, athletic patients. Despite recent advances in both surgical techniques and implant design, recurrent instability remains a concern, with rates as high 30% following both open and arthroscopic approaches. Many risk factors have been identified as potential etiologies of unsuccessful repair, and both glenoid and humeral head bone loss have been implicated. The treatment of glenoid bone loss in the setting of recurrent instability is difficult, mainly because of the nonanatomic (and thus incongruous) joint resulting from most bony augmentation procedures. Recently, the use of fresh osteochondral distal tibia allograft has been described as an alternative for the treatment of large glenoid bone defects in the setting of anterior glenohumeral instability. Initial laboratory work has demonstrated a nearly identical radius of curvature between the distal tibia and the glenoid, even among nonmatched cadaveric specimens. Similar to the glenoid surface, the distal tibia articular surface has excellent conformity to the humeral head throughout a full arc of motion. Biomechanical data show that in the setting of a simulated 30% clinical glenoid defect, reconstruction with the distal tibia allograft can restore the articular conformity of the reconstructed glenoid to nearly the intact state. In addition to having a radius of curvature that allows for unimpeded motion because of its congruency with the humeral head, fresh distal tibia allograft contains dense, weight-bearing corticocancellous bone, making it ideal for screw fixation; it also contains a robust cartilaginous surface that allows for anatomic osteoarticular glenoid surface reconstruction. This video demonstrates a safe, reliable method to repair and rehabilitate patients with large glenoid bone deficiency in the setting of acute and/or recurrent anterior shoulder instability. The background, basic science, typical patient presentation, imaging findings, technique, rehabilitation protocol, and clinical outcomes are reviewed in detail.

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