The Open Eden-Hybinette Procedure for Recurrent Anterior Shoulder Instability With Glenoid Bone Loss

Editorial Commentary: Buttoning Up After Recurrent Anterior Shoulder Instability: The Eden-Hybinette Procedure Is an Effective Salvage After Failed Latarjet

Operative management of anterior glenohumeral dislocation can confer significant improvements in subjective shoulder function, pain, and overall stability. Although the coracoid-based Latarjet procedure has long been considered the ultimate treatment for complex anterior shoulder instability with glenoid or bipolar bone loss, few authors have considered the unimaginable question: what do you do when a patient fails Latarjet? A modified arthroscopic technique of the Eden-Hybinette procedure allows for revision anterior glenoid augmentation of critical glenoid bone loss with autologous tricortical iliac crest, while suture button fixation may obviate hardware complications previously seen with bicortical screw fixation. Although distal tibial allograft provides excellent congruity, viable articular cartilage, and no harvest site morbidity, financial costs and graft availability must also be considered. With favorable patient-reported outcomes, excellent rates of radiographic union, and reliable return to sport, the Eden-Hybinette procedure with suture button-based construct offers a viable alternative for patients with advanced glenoid bone loss (>20%) or revision scenarios.

Revision Shoulder Instability Surgery After Failed Latarjet: Glenoid Reconstruction Using Distal Tibial Allograft and Humeral Head Reconstruction Using Osteochondral Allograft

Revision surgery for a failed Latarjet procedure is rare and technically demanding with few viable options. Similarly, massive defects to the articular humeral head require thoughtful techniques to recreate a congruent joint. Revision options for failed Latarjet have been studied, but there is yet to be a consensus on graft options. Distal tibial allograft has shown favorable outcomes in midterm data. Humeral head osteochondral allograft has also shown favorable outcomes for very large humeral head defects. However, there is a paucity of literature to demonstrate efficacy of combining the 2 aforementioned techniques. Revision shoulder instability surgery with glenoid reconstruction using distal tibial allograft and humeral head reconstruction using osteochondral allograft restores the glenohumeral articulation while preserving the remaining native bone stock.

A novel supplementary anchor fixation technique for reinforcing fixation in bone grafting procedures for shoulder instability

Bony stabilization procedures are a reliable solution for recurrent shoulder instability, but have a steep learning curve due to technical difficulties. Meticulous capsular closure is critical and can be augmented with suture anchor constructs. In addition, although fracture or fragmentation of the coracoid graft is relatively uncommon, it is devastating. Here, we describe the use of additional circumferential suture fixation to improve compression across the graft/glenoid interface and help mitigate the risk of fracture bony augmentation procedures.

Surgical treatment of the humeral head osteochondral defects in chronic shoulder dislocation: Literature review

Background. The shoulder joint is the one most amenable to dislocation. Dislocation of the humeral head is complicated by combined injuries of the shoulder joint, and if the patient does not seek treatment on the first day after the dislocation, irreversible changes in bone and soft tissue structures are formed.The aim of this review was to analyze modern methods of diagnosis and treatment of patients with defects in the articular surfaces of the scapula and humerus head with chronic shoulder dislocations.Material and methods. To search for literature data, we used the electronic databases MEDLINE, PudMed, eLIBRARY with a selection of sources published from 2000 to 2020. The analysis was carried out on works devoted to the diagnosis, surgical treatment and complications of traumatic shoulder dislocations.Results. When analyzing the literature on the surgical treatment of shoulder dislocations, we did not find clear criteria for planning the extent of surgery. The obtained results of surgical treatment testify to well-studied technologies for treating osteochondral defects of the humeral head up to 25 % of its total area. In the presence of a defect of 50 % of humeral head area or more, satisfactory results are shown when carrying out arthroplasty of the joint using a reverse endoprosthesis. However, the treatment of defects ranging in size from 25 to 50 % is still an unexplored problem. There are single techniques using allografts, mainly in English-speaking countries and, to a lesser extent, on the territory of the Russian Federation. Thus, the search for an algorithm for choosing a surgical treatment based on multi-layer spiral computed tomography and/or magnetic resonance imaging data, and the development of a new method of surgical treatment taking into account the obtained data are priority areas in modern traumatology and orthopedics.