Arthroscopic Glenoid Reconstruction, Bone Blocks and Transfers in the Management of Complex Shoulder Instability With Bone Loss: Advanced Concepts and Surgical Techniques: Interactive and Case -Based (AANA22)-Posterior Instability

Video Transcription

Video Summary

A panel discusses an unusually severe posterior shoulder instability case in a 13-year-old girl with frequent, largely atraumatic dislocations requiring repeated ER sedations. Imaging suggested a small, abnormal posterior glenoid and poor posterior-inferior capsular tissue. Surgeons debated nonoperative management versus early surgery, and whether the primary problem was capsular laxity (possibly connective-tissue related) rather than labral injury. The patient underwent arthroscopic posterior stabilization with multiple knotless anchors, but continued to subluxate and developed painful muscle spasms. The spasms resolved after stopping gabapentin, a rare but reported side effect, yet instability persisted. A revision pancapsular plication with even more anchors still failed, and the glenoid width appeared to shrink significantly, likely from erosion and/or anchors. Ultimately, the surgeon performed an arthroscopic posterior bone-block reconstruction using a distal tibial allograft to “make the golf tee bigger,” fixing it with a knotless pulley technique and repairing capsule/labrum to the graft, with outcome pending.

Asset Caption

John M. Tokish, M.D.

Keywords

posterior shoulder instability

pediatric atraumatic dislocations

capsular laxity connective tissue disorder

arthroscopic posterior stabilization knotless anchors

revision pancapsular plication failure

posterior glenoid bone-block distal tibial allograft