Arthroscopic Glenoid Osteochondral Allograft Reconstruction Without Subscapularis Takedown: Technique and Literature Review

The amount of anteroinferior glenoid bone loss is visualized arthroscopically from the posterior portal. The margins of the defect are defined by use of a motorized bur placed through the anterior working portal, allowing for adequate removal of capsulolabral soft tissue until a clear view is obtained. In this way, the osteochondral allograft can be properly fashioned for a precise fit into the glenoid defect.

After the size and shape of the glenoid bone defect are determined, the approximate dimensions are marked on the allograft glenoid. The graft is taken from the same anatomic location that is deficient in the patient, usually the anteroinferior glenoid. With a microsagittal saw, the osteochondral graft is carefully cut from the larger glenoid allograft. Once removed, a towel clip is used to make pilot holes through the margin of the articular surface and periphery of the graft. Two braided, nonabsorbable sutures are then passed for use during graft placement and later repair and tensioning of capsulolabral structures.

The anterior portal incision is then extended approximately 2 cm to accommodate passage of the graft. The allograft is placed into the glenohumeral joint through a capsulotomy in the rotator interval. The arthroscope is placed through the posterior portal to evaluate the fit of the glenoid allograft so that small changes in contour and size can be made to allow for a precise fit. Once the graft shape is satisfactory, it is removed and K-wires are placed to “joystick” the graft into proper position. The K-wires are advanced, and the graft is fixed to native glenoid with 2 cannulated 4.0-mm screws. Anatomic reduction is assessed with the arthroscope, and the nonabsorbable sutures are used to repair capsulolabral structures.