Distal Tibia Allograft for the Management of Anterior Glenoid Bone Loss

Abstract

Recurrent anterior instability of the shoulder remains a growing problem in the young, athletic patient population. Despite recent advances in both surgical technique and implant design, recurrent instability remains a concern, reaching rates as high as 30% following both open and arthroscopic approaches to its correction. Many factors have been identified as potential sources of the unsuccessful repair of anterior instability of the shoulder, among which have been bone loss in both the glenoid and head of the humerus. The treatment of bone loss in the glenoid in the setting of recurrent instability is difficult, mainly because of the nonanatomic and therefore incongruous joint resulting from most bone augmentation procedures at this anatomic site. Recently, the use of fresh osteochondral allografts from the distal tibia has been described as an option for treating large bone defects in the glenoid in the setting of anterior instability of the glenohumeral joint. However, despite cadaveric studies demonstrating the feasibility of using distal tibia allografts for such reconstruction, the lack of published clinical data supporting their use for this purpose mandates caution. This article describes a safe, reliable method for the repair of major glenoid bone deficiency and the rehabilitation of patients with acute and/or recurrent anterior instability of the shoulder.

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