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Arthroscopic Augmentation of Posterior Glenoid Defects With Iliac Crest Autograft

March 01, 2020

Contributors: Charles Mitchell Jobin, MD, FAAOS; Cesar David Lopez, BS; Hasani Swindell, MD; Julian Sonnenfeld, MD

Glenoid bone loss is a substantial risk factor for failed arthroscopic shoulder stabilization. Although anterior shoulder instability has been well studied, limited options are available for glenoid reconstruction in patients with posterior shoulder instability and posterior glenoid bone loss. Posterior shoulder instability is rare, accounting for 4% of all shoulder instability. The reconstruction technique most commonly used to manage posterior glenoid reconstruction involves the use of iliac crest autograft as a posterior bone block. This autograft is used in patients with involuntary posterior shoulder instability in whom nonsurgical treatment fails, and the procedure can be performed arthroscopically or via open surgery. Although the number of studies on arthroscopic bone grafting for the management of posterior instability is limited, arthroscopic augmentation of posterior glenoid defects with the use of iliac crest autograft is associated with promising results, improving the accuracy of graft placement and the quality of soft-tissue repair. This video demonstrates all-arthroscopic posterior glenoid reconstruction and augmentation with the use of an iliac crest autograft. The goals of the procedure are to successfully reconstruct the posterior glenoid with the use of an iliac crest autograft, restore shoulder function and stability, and afford long-term pain relief. The video reviews the indications, contraindications, and techniques for successful arthroscopic glenoid reconstruction and correction. Preoperative imaging studies, operating room setup, patient positioning, surgical approach, postoperative management, and expected outcomes are described.