1. Bipolar Bone Loss of the Shoulder Joint due to Recurrent Instability: Use of Fresh Osteochondral Distal Tibia and Humeral Head Allografts 
Daniel B. Haber, M.D., Anthony Sanchez, B.S., George Sanchez, B.S., Marcio B. Ferrari, M.D., Sami Ferdousian, B.S., Matthew T. Provencher, M.D. 
Arthroscopy Techniques 
Volume 6, Issue 3, Pages e893-e899 (June 2017)
DOI: /j.eats
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
For full exposure of the Hill-Sachs lesion, the left shoulder is externally rotated. Using a surgical pen, the border of the osteochondral defect is marked and used as reference (A, blue arrows). Then, an oscillating sagittal saw is used to cut along the marked border of the defect to produce the “orange-slice” shape (B, yellow arrow) for allograft fixation.
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Preparation of the humeral head allograft for fixation onto the Hill-Sachs lesion of the left shoulder is shown. To ensure the optimal sizing of the graft, the defect is measured using a surgical ruler. Then, the allograft is marked using a surgical pen in the same region as the defect (yellow arrow) of the native humeral head (A). Once the measurements are performed, an oscillating saw (yellow arrow) is used to perform the cuts (B) and fashion an “orange slice” shape (yellow arrow) allograft (C), which will fill the defect of the humeral head.
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
After the cuts to prepare the humeral head allograft for the left shoulder, a surgical ruler (yellow arrows) is used to ensure that the allograft is appropriately sized. The width, length, and height are measured (A-C), and compared with the measurements of the defect dimensions. If necessary, minimal adjustments are made at this point to arrive at the best fit of the allograft into the defect.
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Once the humeral head fresh allograft for the left shoulder is of optimal size, two 0.7-mm Kirschner wires (black arrows) are placed into the allograft (A). The wires will be used to transport the graft (*) to the prepared defect of the native humeral head (blue arrow). Once the graft is in the desired position, the Kirschner wires are advanced to secure the graft in the optimal position (B).
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

6. Fig 5
For definitive fixation of the humeral head allograft onto the engaging Hill-Sachs lesion of the left shoulder, four 4.0-mm headless compression screws (Arthrex, Naples, FL) are used. Note the restoration of the native anatomy (blue arrow) after fixation of the humeral head allograft.
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

7. Fig 6
After fixation of the humeral head allograft onto the left shoulder, attention is turned to the glenoid bone loss, which will be treated via fixation of a distal tibia allograft. Before allograft fixation, the lateral one third of the distal tibial plafond is prepared on the back table. Using a surgical pen, the graft is first marked (yellow arrows) for cuts to be made in accordance with the measured dimensions of the defect (A-C).
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

8. Fig 7
Preparation of the distal tibial allograft (yellow arrow) to address glenoid bone loss of the left shoulder is shown. Once the dimensions of the distal tibia allograft are outlined, the graft is shaped using a small oscillating saw (yellow arrow). Of note, the assistant must provide saline solution irrigation throughout the cuts to minimize the risk of thermal necrosis.
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

9. Fig 8
For definitive fixation of the distal tibial allograft to the glenoid in this left shoulder, two 3.5-mm noncannulated fully threaded cortical screws (blue arrows) (between 32 and 38 mm in length) with suture washers (Arthrex, Naples, FL) are used. Once both grafts are secured, the glenohumeral joint is reduced. Finally, full restoration of contact between the glenoid and humeral head (white arrow) is confirmed to ensure stability of the joint.
Arthroscopy Techniques 2017 6, e893-e899DOI: ( /j.eats )
Copyright © 2017 Arthroscopy Association of North America Terms and Conditions