Arthroscopic Anterior and Posterior Glenoid Bone Augmentation With Capsular Plication for Ehlers-Danlos Syndrome With Multidirectional Instability Mitchel.

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Presentation transcript:

Arthroscopic Anterior and Posterior Glenoid Bone Augmentation With Capsular Plication for Ehlers-Danlos Syndrome With Multidirectional Instability Mitchel D. Armstrong, M.D., B.M.Sc., Benjamin Smith, M.D., F.R.C.S.(C.), Catherine Coady, M.D., F.R.C.S.(C.), Ivan H. Wong, M.D., M.A.C.M., F.R.C.S.(C.) Arthroscopy Techniques Volume 7, Issue 5, Pages e541-e545 (May 2018) DOI: 10.1016/j.eats.2018.01.011 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 Patient is placed in the lateral decubitus position and rolled 30° posteriorly with the ipsilateral hip prepped for iliac crest tricortical graft harvest. A standard posterior portal is created and kept slightly medial in order to stay parallel with the glenoid face. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 Standard arthroscopic portals are made. Portal 1, standard posterior portal; portal 2, posterolateral portal; portal 3, direct medial portal; portal 4, anterosuperior (AS) portal. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 Left shoulder. Viewing from anterosuperior portal. Calibrated probe is placed through the posterior portal. The defect size is then measured to confirm graft size. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 4 The harvested iliac crest bone graft has 2 k-wires placed using the alpha-beta guide to prepare screw tracks. This technique is used to prepare both the anterior and posterior glenoid augment grafts. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 5 The double-barrel cannula is secured to the prepared graft in readiness for insertion into the shoulder. This cannula allows for ease of stable graft passage into the shoulder. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 6 Left shoulder viewed from the anterosuperior portal; the graft (black arrow) is placed flush to the anterior glenoid surfaced. Note the 1-mm rim of denuded cartilage (blue arrow) that will serve for later capsular repair. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 7 Left shoulder, anterosuperior viewing portal. Fixation of the anterior glenoid augment graft. Two 3.5-mm titanium screws are passed over the top of the guide wires within the double-barrel cannula (black arrow). Anterior graft (blue arrow). Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 8 Left shoulder, viewed from the anterosuperior portal. Anterior graft (blue arrow) is to the right of the picture. The capsule (black arrow) is secured along the edge of the patient's native glenoid, keeping the graft extra-articular. Arthroscopy Techniques 2018 7, e541-e545DOI: (10.1016/j.eats.2018.01.011) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions