Authors:
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All the authors declare no conflict of interest.
INTRODUCTION:
Anterior shoulder instability with significant glenoid bone loss poses a complex surgical challenge. While the Latarjet procedure has proven effective, its traditional approach may compromise subscapularis integrity. This video demonstrates an arthroscopic alternative using a fresh distal tibia allograft without splitting the subscapularis tendon, thereby reducing neuromuscular risk and preserving rotator cuff function. The technique is based on recent anatomical and biomechanical studies supporting the use of structural grafts for glenoid defects >20%.
TECHNIQUE DESCRIPTION:
The patient is placed in the beach-chair position. Following arthroscopic assessment and controlled reaming of the glenoid bed, a 1.5 cm anterior incision is made for graft introduction. A key feature of this technique is the absence of a formal subscapularis split. Instead, with the arm in external rotation, a small split (~2 mm) is made in the superior fibers of the tendon. During graft passage, internal rotation of the arm facilitates inferior displacement of the subscapularis, allowing controlled insertion of the graft without compromising its structure.
RESULTS:
The procedure was recently performed; thus, no imaging is yet available to confirm graft integration. However, the patient has demonstrated favorable functional recovery in the early postoperative weeks, with no signs of instability or complications.
ANNEXES
Written informed consent was obtained for the use of clinical and audiovisual material, in accordance with the principles of the Declaration of Helsinki.
REFERENCES.
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Provencher MT, et al. Arthroscopic Glenoid Reconstruction with Distal Tibia Allograft: Technique and Preliminary Results. Arthroscopy. 2016;32(3):476-483.
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Wong IH, Urquhart N. Arthroscopic anatomic glenoid reconstruction without subscapularis split. ArthroscTech.2015;4(5):e533-e540.
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Boileau P, et al. All-Arthroscopic Latarjet Procedure: Technical Notes and Clinical Outcomes.JBJS.2019;101(15):1301-1311.
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Frank RM, et al. Distal Tibial Allograft for Glenoid Bone Loss. Arthroscopy. 2018;34(9):2631-2643.
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Amar E, Konstantinidis G, Coady C, Wong IH. Arthroscopic treatment of shoulder instability with glenoid bone loss using distal tibial allograft augmentation: safety profile and short-term radiological outcomes. Orthop J Sports Med. 2018;6(5):2325967118774507.
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Gilat R, Wong SE, Lavoie-Gagne O, et al. Outcomes are comparable using free bone block autografts versus allografts for anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of “the Non-Latarjet”. Knee Surg Sports Traumatol Arthrosc. 2021;29(7):2159-2174.
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Singh M, Byrne R, Chang K, et al. Distal tibial allograft for the treatment of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis. Am J Sports Med. 2023;51(4):1052-1060.
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