AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-ANTERIOR BONE BLOCK SURGERY_ CORACOID, ICBG, DTA & DISTAL CLAVICLE-Grant E. Garrigues, MD

ANTERIOR BONE BLOCK SURGERY_ CORACOID, ICBG, DTA & DISTAL CLAVICLE-Grant E. Garrigues, MD

Pdf Summary

This document by Dr. Grant E. Garrigues provides a comprehensive overview of anterior bone block surgeries for shoulder instability involving coracoid, iliac crest bone graft (ICBG), distal tibia allograft (DTA), and distal clavicle autograft.

Key points include:

1. <strong>Problem of Bony Defects:</strong> Glenoid bone loss significantly increases recurrent shoulder instability after arthroscopic Bankart repair. Defects as small as 13-20% can compromise stability and range of motion. The “glenoid track” concept explains how combined bone loss on the glenoid and humeral head (Hill-Sachs lesion) predisposes to engagement and dislocation.

2. <strong>Assessment of Bone Loss:</strong> Techniques such as the bare spot measurement and best-fit circle method are used arthroscopically and radiographically to quantify bone loss and guide treatment.

3. <strong>Treatment Algorithm:</strong> 
   - <15% bone loss: Arthroscopic Bankart repair typically recommended.
   - 15-25%: Caution; may require open bone augmentation or incorporation of bony fragments.
   - >25%: Open bone augmentation procedures preferred.

4. <strong>Latarjet Procedure (Coracoid Transfer):</strong> A well-established, non-anatomic but effective bone block surgery. It increases anterior glenoid width and provides a dynamic sling effect. It has a complication rate up to 20%, but offers low recurrence (around 3.5%), good return to sport, and durable results with reported 5+ year follow-up. It can be done open or arthroscopically, with similar outcomes.

5. <strong>Iliac Crest Bone Graft (Eden-Hybinette):</strong> Autologous bone grafting useful for large glenoid defects where coracoid is insufficient. It has higher rates of osteoarthritis and donor site morbidity compared to Latarjet. Arthroscopic techniques for Eden-Hybinette have shown promising early results.

6. <strong>Distal Clavicle Autograft:</strong> Emerging option that provides autologous osteochondral graft with minimal donor morbidity. Early pilot studies and biomechanical data show potential advantages.

7. <strong>Distal Tibia Allograft:</strong> Offers dense weight-bearing bone with robust cartilage, good availability, and customizable sizing. Studies show good graft healing, incorporation, and low rates of recurrent instability.

8. <strong>Outcomes:</strong> Bone block procedures remain gold standard for significant glenoid bone loss, with multiple graft options available. Choice depends on defect size, graft availability, and surgeon expertise.

In sum, anterior bone block surgery using various grafts is critical in treating recurrent shoulder instability associated with bony defects, improving stability, function, and return to sport while minimizing recurrence.

Keywords

anterior bone block surgery

shoulder instability

glenoid bone loss

Latarjet procedure

iliac crest bone graft

distal tibia allograft

distal clavicle autograft

arthroscopic Bankart repair

bone augmentation

glenoid track