Wichan Kanchanatawan, M. D. , Jatupon Kongtharvonskul, M. D. , Ph. D

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Presentation transcript:

Arthroscopic Bone Grafting for Anteroinferior Glenoid Defect Using Template Wichan Kanchanatawan, M.D., Jatupon Kongtharvonskul, M.D., Ph.D., Kaiwan Sriruanthong, M.D., Gem Dorjiee, M.D. Arthroscopy Techniques Volume 5, Issue 6, Pages e1229-e1234 (December 2016) DOI: 10.1016/j.eats.2016.07.010 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 The patient is placed in the beach-chair position (60°) with the ipsilateral iliac crest (arrow) prepared. Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) The anteroinferior portal is created using a surgical blade through the mid-subscapularis tendon. (B) An 8-mm cannula (Arthrex) (P) is inserted aiming toward the defect area and serves as the main working portal. (G, glenoid; H, humeral head; Sc, subscapularis tendon.) Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Three-hole, 2.7-mm plate (Synthes). Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 (A) The template is placed at the anteroinferior glenoid defect using the suture railroad (arrow). (B) Drilling and tapping are performed using a 3.5-mm cannulated screw system (Synthes) at 2 caudad holes (arrow). Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Sizing, drilling, and tapping guided by the same template are performed before the graft harvest. The width of the iliac graft is designed to be 2 to 3 mm wider than the template (black arrow) with the length long enough to cover 2 holes of the template (white arrow), and the height is approximately 10 mm. The harvested graft measures 10 × 20 × 10 mm (inset). Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 The iliac graft with the suture railroad in the upper hole (white arrow) is inserted through the anterosuperior portal using a slit cannula (red arrow) modified from a 10-mL plastic syringe (Terumo). The black arrow indicates the anteroinferior portal. Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 (A) Slit cannula modified from a 10-mL plastic syringe (Terumo). (B) Folding the leading part (arrow) allows easier insertion. Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 The iliac bone graft is fixed by a 3.5-mm cannulated screw system (Synthes). An arthroscopic view from the posterior portal shows stable fixation with the concave inner table of the iliac graft staying flush with the articular glenoid surface (inset). (BG, iliac bone graft; G, glenoid; H, humeral head.) Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 (A, B) Patient's clinical status 6 weeks after surgery. Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 10 (A, B) Three-dimensional computed tomography scans confirmed the exact placement of the iliac graft at the anteroinferior glenoid defect (arrows). Arthroscopy Techniques 2016 5, e1229-e1234DOI: (10.1016/j.eats.2016.07.010) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions