Ivan H. Wong, M. D. , M. Sc. , F. R. C. S. C. , Dip

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Presentation transcript:

Arthroscopic Anatomic Glenoid Reconstruction Without Subscapularis Split Ivan H. Wong, M.D., M.Sc., F.R.C.S.C., Dip. Sports Medicine, Nathan Urquhart, M.D., M.Sc., F.R.C.S.C., Dip. Sports Medicine Arthroscopy Techniques Volume 4, Issue 5, Pages e449-e456 (October 2015) DOI: 10.1016/j.eats.2015.04.005 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 Semi-lateral position with pneumatic arm holder. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 Frozen distal tibia allograft is used as the donor graft. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 Micro sagital saw is used to prepare the graft segment. The posterolateral corner tends to have the best contour. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 4 DePuy Mitek Bristow-Latarjet Instability Shoulder System guide is used to place two guide wires, which are then overdrilled with the cannulated drill. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 5 The grafts are then tapped and top-hat washers placed to dissipate hoop stresses when later tightened. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 6 The double barrel cannula system is then attached to the graft via the top-hat washers. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 7 A switching stick placed in the posterior portal is used to shift the subscapularis inferiorly allowing the graft to be placed without splitting the subscapularis muscle. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 8 Guide wires are placed to temporarily affix the graft in proper position on the glenoid before drilling and placing the cannulated screws. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 9 Allograft in position viewed from the (A) anteriosuperior and (B) posterior portals. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 10 Bankart style capsule/labral reattachment. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 11 Postoperative incisions. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 12 Postoperative computed tomography scan. Arthroscopy Techniques 2015 4, e449-e456DOI: (10.1016/j.eats.2015.04.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions