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Surgical Management of Traumatic Anterior Shoulder Instability via Tricortical Cryopreserved Iliac Crest Allograft

March 01, 2019

Contributors: Young W Kwon, MD, PhD, FAAOS; Dylan Lowe, MD; Mikhail Zusmanovich, MD; Mikhail Zusmanovich, MD

Anterior shoulder instability is a substantial problem for many young patients who sustain a traumatic anterior shoulder dislocation. Management of primary shoulder dislocations can be nonsurgical; however, recurrent anterior instability that results in apprehension, weakness, and inability to participate in sports activity often occurs. Although several surgical strategies are available to treat patients with recurrent anterior shoulder instability, patients with a large glenoid defect usually require restoration of the bony surface to restabilize the joint. Tricortical cryopreserved allograft has been used to successfully treat these patients. This video demonstrates restoration of the glenoid bone surface via a tricortical cryopreserved allograft. This video provides an overview of the pathogenesis, diagnosis, and management of anterior shoulder instability and glenoid bone loss. The video discusses the case presentation of a 25-year-old man with anterior shoulder instability and approximately 30% glenoid bone loss. Shoulder capsulorrhaphy and glenoid bone stock restoration with the use of a tricortical cryopreserved allograft was performed. The procedure was successful, and the glenoid bony anatomy was restored. The patient was advanced through a standardized rehabilitation protocol. The patient reported substantially improved pain 2 months postoperatively. The patient denied any recurrence or sensation of instability and is making progress toward his goal of returning to full functional capacity, including sports activity. Surgical restoration of glenoid bone stock via tricortical cryopreserved allograft is a reliable treatment option for patients with anterior shoulder instability and greater than 25% glenoid bone loss. Early results suggest good to excellent radiographic and clinical outcomes.

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