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.
Edited By: Frederick A. Matsen III, M.D., Winston J. Warme, MD
Last updated Friday, October 16, 2009
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Figure 4 - Separating the subscapularis tendon from the underlying capsule provides access to the site where the graft will be placed
Figure 5 - The graft is harvested from the iliac rest (hip beltline) on the same side as the shoulder reconstruction
Figure 6 - The bone graft is taken from the upper outer aspect of the iliac crest at the beltline. After the harvest, the muscle attachments are repaired.
Figure 7 - Drilling and then screwing the graft to the glenoid provides firm fixation in the desired location
Figure 8 - Extra capsular graft placement: Screw fixation of the graft outside the capsule allows the capsule to protect the humeral head from the graft. Once fixed in position, the graft can be finely contoured.
Figure 8 - Extra capsular graft placement: Screw fixation of the graft outside the capsule allows the capsule to protect the humeral head from the graft. Once fixed in position, the graft can be finely contoured.
About the procedure
Technical details
Revision surgery for shoulder instability is a highly technical
procedure; each step plays a critical role in the outcome.
After the anesthetic has been administered and the shoulder and hip are
prepared, an incision is made across the front of the shoulder. The
incision from a previous repair may be used for this procedure.
Otherwise an incision is made in the anterior skin crease of the
shoulder.
The hip incision is made just below the beltline near the front of the hip.
The shoulder incision allows access to the joint without damaging
the important deltoid or pectoralis muscles that are responsible for a
significant portion of the shoulder's power.
The muscles and other tissues near the shoulder are mobilized by
removing any scar tissue that may restrict their motion. This may be
difficult if previous surgery has resulted in excessive scarring or if
implants or sutures need to be removed and dissected from the normal
tissues.
The subscapularis tendon is cut to allow access to the joint and
then split from the capsule that lies beneath it. This split reveals
the front of the bone of the socket where the bone graft will be placed
and secured.
The graft is then harvested from the iliac crest by detaching the
muscles that attach there. A segment of bone measuring about 4 cm by 4
cm by 1 cm is harvested. The muscles are then reattached.
This bone graft is then shaped to fit on the front of the glenoid
and fixed there with two screws. The graft is placed so that the
capsule lies between the humeral head and the graft. After the graft
has been secured in position, its contour can be finely adjusted.
After the graft is in position, the stability of the shoulder is
examined. At the conclusion of the procedure, the subscapularis tendon
and capsule are repaired.
Anesthetic
Revision instability surgery may be performed under a general
anesthetic or under a brachial plexus nerve block. A brachial plexus
block can provide anesthesia for several hours after the surgery. If a
plexus block is used, additional anesthesia is necessary for the iliac
crest harvest. The patient may wish to discuss their preferences with
the anesthesiologist before surgery.Length of surgery to deepen the socket of anteriorly dislocating shoulders (using an anterior iliac crest bone graft)
The procedure usually takes approximately two hours, however the
preoperative preparation and the postoperative recovery may add several
hours to this time. Patients often spend two hours in the recovery room
and two to four days in the hospital after surgery
Surgery for failed surgery for anterior dislocation at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington
If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-BONE (2663) to make an appointment. Our clinical center is located in Seattle Washington, USA
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