AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Anterior Bone Block Surgery_ Coracoid, ICBG, DTA & Distal Clavicle-Grant E. Garrigues, M.D.

Anterior Bone Block Surgery_ Coracoid, ICBG, DTA & Distal Clavicle-Grant E. Garrigues, M.D.

Pdf Summary

This presentation by Dr. Grant E. Garrigues discusses anterior bone block surgeries for shoulder instability involving glenoid bone loss, focusing on graft techniques including coracoid transfer (Latarjet), iliac crest bone grafting (Eden-Hybinette), distal tibia allograft, and distal clavicle autograft.<br /><br />Key issues include the high recurrence rates of instability after arthroscopic Bankart repair, especially in patients with significant glenoid bone defects. Studies cited show that bone loss as low as 13-20% of the glenoid can significantly increase instability risk. The "glenoid track" concept highlights how size and location of bone loss and Hill-Sachs lesions determine engagement risk. Measurement techniques like bare spot, best-fit circle, Pico, and glenoid width methods quantify bone defects.<br /><br />The Latarjet procedure (coracoid transfer) is a non-anatomic but reliable option creating an anterior bone block and "sling effect," with low recurrence rates and acceptable complication profiles. Advances include arthroscopic Latarjet, which shows similar outcomes with decreased early pain compared to open surgery. Long-term data demonstrate durability, safety, and good return to sport. However, it carries a 20% complication rate, including neurologic risks.<br /><br />The Eden-Hybinette procedure uses autologous iliac crest bone graft for larger defects; while effective, it has graft site morbidity and higher rates of osteoarthritis than Latarjet. Arthroscopic techniques have been developed to reduce morbidity.<br /><br />Distal tibia allograft offers a dense, cartilage-bearing option with good availability and favorable healing rates in glenoid reconstruction for larger defects. Distal clavicle autograft, a newer strategy, provides osteochondral tissue with minimal donor morbidity and promising early outcomes.<br /><br />Overall, bone block procedures remain the gold standard for recurrent anterior shoulder instability with significant bone loss. Optimal treatment depends on defect size, patient factors, and graft availability, with ongoing research refining surgical approaches and graft selection for improved long-term stability and joint preservation.

Keywords

anterior bone block

shoulder instability

glenoid bone loss

Latarjet procedure

Eden-Hybinette procedure

distal tibia allograft

distal clavicle autograft

glenoid track

arthroscopic Bankart repair

bone graft techniques