Anterior glenoid reconstruction for unstable dislocating shoulders. Surgery to restore lost anterior glenoid bone and deep the socket with a bone graft can restore shoulder anatomy and lessen pain and improve function.

Figure 1 - Anatomically Contoured Extracapsular Iliac Crest Bone Graft: Bone graft inserted at the front of the glenoid socket helps restore shoulder stability

Summary

What are the key points about surgery to deepen the socket of anteriorly dislocating shoulders (using an anterior iliac crest bone graft) for failed surgery for anterior dislocation?

A Bankart repair is usually successful in stabilizing a shoulder with recurring dislocations. However, sometimes surgery can fail to stabilize the shoulder, either because the repair is not strong enough or because the socket of the shoulder is compromised. In these situations, a contoured bone graft may provide the needed stability by deepening the socket.

After performing a careful history and a clinical examination, a surgeon experienced in complex reconstructions for instability can determine if socket deficiency is contributing to the recurrent dislocations of the shoulder. Patients are most likely to benefit from this surgery if they are well motivated, in good health and have not been smoking.

The goal of the bone graft surgery is to build up the socket so that it provides more stability for the joint.

The bone graft is harvested from the iliac crest (hip bone at the belt line), shaped, and then screwed to the front of the socket. It is placed outside the capsule of the shoulder so that the bone graft does not rub directly on the cartilage of the humeral head (the ball of the shoulder joint).

Anatomically contoured iliac crest grafting is a highly technical procedure and is best performed by a surgical team who performs this surgery often. Such a team can maximize the benefit and minimize the risks. The two-hour procedure is performed under general (or nerve block) anesthesia. If a shoulder nerve block is used, additional anesthesia is needed for the graft donor site.

Shoulder motion is started immediately after the procedure. Patients learn to do their own physical therapy and are usually discharged three days after surgery if they are comfortable and have a good range of passive motion. The recovery of strength and function may continue for up to a year after surgery.

Articles of interest on Anterior inferior Bone Grafting (PDF)

10 surgery questions for your surgeon before having surgery

Surgery for failed surgery for anterior dislocation at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

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