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Chapter 08 Video 1: Distal Tibial Allograft for Glenoid Bone Loss and Loss of Articular Cartilage

May 02, 2016

Contributors: CAPT (Ret) Matthew T. Provencher, MD MC USNR

This video demonstrates the use of distal tibial allograft for treating glenoid bone loss and loss of articular cartilage. Approaches to shoulder instability are discussed, and the advantages and disadvantages of fresh distal tibia allograft allograft are emphasized. These include that distal tibia graft includes a cartilage surface, the fact that the radius of curvature closely approximates that of the glenoid, and that cancellous bone from this area is dense. Glenohumeral instability is demonstrated, and patient set up is discussed.  The procedure is performed via an open approach, and the anterior glenoid is burred and rasped to bleeding bone to accommodate the graft. The fresh allograft is cut from the lateral aspect of the distal tibia, K wires are inserted to aid in insertion, and the graft is pulse lavaged to remove marrow elements. The graft is inserted, and screws with washers and sutures are inserted close to parallel to the surface of the glenoid in a lag fashion.  The K wires are removed and the capsule repaired to sutures attached to the washer.   The procedure has had good initial and early results, demonstrating solid incorporation on CT scan, and is a good option for significant bone loss (>25-30%), prior failed open bone graft procedures (Latarjet), or failed open procedures.