Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device  Socrates Kalogrianitis, M.B.Ch.B., F.R.C.S., Vasileios Tsouparopoulos, M.D.  Arthroscopy Techniques  Volume 5, Issue 6, Pages e1197-e1202 (December 2016) DOI: 10.1016/j.eats.2016.07.007 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Posterior glenoid guide with a 7-mm offset that allows the introduction of two 3-mm cannulated drills through the glenoid neck. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 TightRope-RT, a knotless, adjustable-length suture and button device. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Step 1: preparation of glenoid (left shoulder, beach-chair position, 30° arthroscope through anterolateral portal). The anterior glenoid neck is prepared to a flat surface using a rasp that is introduced through the rotator interval portal. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Step 2: positioning of glenoid guide (left shoulder, beach-chair position, 30° arthroscope through anterolateral portal). The posterior glenoid guide is introduced into the joint, parallel to the glenoid surface, and its tip is anchored at the 4-o'clock position. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 5 Step 3: passage of TightRopes (left shoulder, beach-chair position, viewing from above). The TightRopes are passed through the glenoid, brought out through the rotator interval, and loaded on the iliac crest graft. Two Dog-Bone buttons are attached to the loops of the TightRopes. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 6 Step 4: positioning of iliac crest graft (left shoulder, beach-chair position, 30° arthroscope through anterolateral portal). The graft is introduced at the anterior glenoid neck, centered at the 4-o'clock position. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 7 Step 5: tensioning of TightRopes (left shoulder, beach-chair position, viewing from above). A suture tensioner is used to sequentially tension the TightRopes at 100 N. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 8 (A) Preoperative 3-dimensional computed tomography scan of left shoulder showing significant anterior bone loss. (B) Postoperative 3-dimensional computed tomography scan of the same shoulder with the bone graft positioned flush with the anterior glenoid and secured with 2 TightRope-RT devices. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 9 Step 6: Bankart repair (left shoulder, beach-chair position, 30° arthroscope through posterior portal). The LabralTape is loaded on a 2.9-mm BioComposite PushLock anchor that is inserted at the predrilled hole at the 3-o'clock position. Arthroscopy Techniques 2016 5, e1197-e1202DOI: (10.1016/j.eats.2016.07.007) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions