Glenoid drill

PURPOSE: The open Trillat Procedure described to treat recurrent shoulder instability, has a renewed interest with the advent of arthroscopy. The suprascapular nerve (SSN) is theoretically at risk during the drilling of the scapula near the spinoglenoid notch. The purpose of this study was to assess the relationship between the screw securing the coracoid transfer and the SSN during open Trillat Procedure and define a safe zone for the SSN. METHODS: In this anatomical study, an open Trillat Procedure was performed on ten shoulders specimens...

PURPOSE: Adequate position of the bone block during arthroscopic Latarjet procedure is critical for an optimal functional outcome. However, this procedure is complex with a long learning curve. Our aim was to compare the bone block position between a dedicated glenoid posterior instrumentation and suture button fixation versus an anterior screw fixation, on a postoperative computed tomography (CT) scan. METHOD: Seventy-nine consecutive patients operated on for an anterior shoulder instability were included in this retrospective study...

Glenoid bone loss in patients with recurrent anterior shoulder instability poses a unique challenge to treating surgeons. Various bone block procedures have been used to reconstruct the glenoid, including autologous coracoid transfer, iliac crest autograft, distal clavicle autograft, and distal tibia allograft. Distal tibia allograft has been increasingly used because of its advantages over autologous graft sources. Having started out as an open procedure, glenoid reconstruction with distal tibia allograft has now found its way to evolving into an arthroscopic procedure...

The proposed benefits of stemless humeral implants include greater bone preservation, decreased cortical stress shielding, less risk of diaphyseal stress risers, decreased surgical time, and greater ease of implant removal during revision surgery. In part 3 of this comprehensive technique series on the management of glenohumeral arthritis, we present our step-by-step surgical technique for use of a patient-specific 3-dimensionally printed glenoid drill guide, placement of a stemless anatomic total shoulder prosthesis, and subscapularis repair, and we highlight our protocol for postoperative rehabilitation...

BACKGROUND: Compared with the Latarjet procedure, the Bristow procedure has a lower screw-related complication rate but poor bone healing. A modified Inlay Bristow procedure has been reported to significantly improve the bone healing rate, but the biomechanical mechanism is unclear. The aim of this study was to evaluate the biomechanical stability of the bone graft between a modified Inlay Bristow procedure and the classic Bristow procedure. METHODS: Sixteen left scapula models (Sawbones, Composite Scapula, 4th generation) were randomly divided into two groups (8:8)...

BACKGROUND: Traditional, commercially-sourced patient-specific instrumentation (PSI) systems for shoulder arthroplasty improve glenoid component placement but can involve considerable cost and outsourcing delays. The purpose of this randomized controlled trial was to compare the accuracy of glenoid component positioning in anatomic total shoulder arthroplasty (aTSA) using an in-house, point-of-care, 3-dimensionally (3D) printed patient-specific glenoid drill guide versus standard non-specific instrumentation...

Recurrence of anterior instability after a Latarjet procedure with persistent glenoid bone loss can be related to coracoid bone block resorption, migration, or malposition. Multiple options are available to address anterior glenoid bone loss, including autograft bone transfers (such as iliac crest graft, distal clavicle autograft) or allografts (distal tibia allograft). Here, we present the use of the remnant coracoid process as an option for consideration in the treatment of glenoid bone loss after failed Latarjet procedure with persistent glenoid bone loss...

Arthroscopic distal clavicle autograft represents a locally available source of autograft for bone block augmentation in patients with anterior shoulder instability with glenoid bone loss. Anatomic and biomechanical studies have supported distal clavicle autograft use as comparable to coracoid graft with regard to restoration of glenoid articular surface, with the theoretical advantage of minimizing complications associated with coracoid transfer procedures, such as neurologic injury and coracoid fracture. The current technique describes a modification of those previously described, including a mini-open approach for distal clavicle autograft harvest, orientation of the distal clavicle with the medial clavicle graft against the glenoid (congruent arc), an all-arthroscopic technique of graft passage, and graft placement and fixation using specialized drill guides and four suture buttons to reproducibly place and secure the graft with final capsulolabral advancement over the graft to render it extra-articular...

BACKGROUND: Deciding how many anchors to use in a Bankart repair is challenging because of the desire to enhance stability while avoiding postage stamp fracture of the glenoid rim. METHODS: This controlled laboratory study investigated load to fracture of the anterior glenoid rim after drilling holes of varying number and diameter and inserting anchors of two different types and sizes, with and without perforation of the medial cortex of the glenoid, creating postage stamp fractures using a metallic humeral head that was compressed against the anterior glenoid rim...

PURPOSE: Mixed reality-guided surgery through head-mounted displays (HMDs) is gaining interest among surgeons. However, precise tracking of HMDs relative to the surgical environment is crucial for successful outcomes. Without fiducial markers, spatial tracking of the HMD suffers from millimeter- to centimeter-scale drift, resulting in misaligned visualization of registered overlays. Methods and workflows capable of automatically correcting for drift after patient registration are essential to assuring accurate execution of surgical plans...

BACKGROUND: Preoperative planning software and intraoperative guidance technology is being increasingly used for managing complex glenoid deformity in anatomic and reverse total shoulder arthroplasty (aTSA; rTSA). The aim of this study is to review the intraoperative efficacy and complications of computer assisted navigation (CAN) surgery for treating glenoid deformity in TSA. METHODS: A retrospective review was performed of all the TSAs implanted using a single computer navigation shoulder system...

INTRODUCTION: Excessive version and inclination of the glenoid component during total shoulder arthroplasty can lead to glenohumeral instability, early loosening, and even failure. The orientation and position of the central pin determine the version and inclination of the glenoid component. The purpose of this study was to compare the differences in centerline position and orientation obtained using "3D preoperative planning based on the best-fit method for glenoid elements" and the surgeon's manipulation...

Anterior bone grafting is an established and frequently used treatment option for recurrent anterior shoulder instability in combination with significant glenoid bone loss. Several open and arthroscopic fixation techniques have been presented to this field in recent years. Some of these techniques are associated with different peri- and postoperative problems or complications. Therefore, the technical gold standard for anterior bone grafting has not been determined, resulting in an ongoing evolvement of bone-grafting techniques...

BACKGROUND: There are no generally accepted guidelines for polyethylene (PE) glenoid component cementation techniques. In particular, it is not known whether the backside of a PE glenoid should be fully or partially cemented, or not cemented at all. We hypothesized that cementing technique has an impact on cement mantle volume and integrity as well as on biomechanical stability, measured as micromotion under cyclic loading. METHODS: To address this question, three different cementation techniques of a single two-peg PE glenoid design into a polyurethane foam were compared with regard to (a) the quality and quantity of the cement mantle and (b) the biomechanical stability after cyclic loading in vitro...

PURPOSE: Suprascapular nerve (SN) at the spinoglenoid notch is a mobile structure which is vulnerable to iatrogenic injury from screw or guidewire penetration during shoulder surgery such as Latarjet procedure or SLAP/Bankart repairs. The primary objective is to identify the distance between posterior glenoid and SN in different shoulder abduction and rotation. The secondary objective is to identify the distance in standard lateral decubitus position. METHODS: Nineteen shoulders from 10 Thiel embalmed soft cadavers were used in this study...

Recurrent shoulder instability and its role in bone loss from the anterior glenoid is well recognized throughout the literature. This technique paper presents an all-arthroscopic technique that uses distal tibial allograft and double-button suture fixation to address anterior recurrent shoulder instability. With the patient in the lateral decubitus position, we use the posterior portal to position the double-barrel drill guide tangential to the face of the glenoid, while viewing through the anterosuperolateral portal...

BACKGROUND: While 2 screws are traditionally used for coracoid bone block fixation, no gold standard technique has yet been established when using cortical buttons. PURPOSE: To compare anatomic and clinical outcomes of the arthroscopic Latarjet procedure using either 2 or 4 buttons for coracoid bone block fixation. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 23 patients with 4-button fixation (group 4B) were matched for age at surgery, sex, and follow-up to 46 patients who had 2-button fixation (group 2B)...

Shoulder instability is a commonly seen pathology. The Latarjet procedure was first described in 1954 to address recurrent instability or patients with glenoid bone loss. Since its introduction, the procedure has been widely adopted and modified, including being performed all-arthroscopically. Various arthroscopic techniques have been described, but we present a technique performed in the lateral decubitus position that takes advantage of a pneumatic arm holder. After arthroscopic diagnosis, multiple accessory portals are established and used to accomplish the technique...

Arthroscopic distal clavicular autograft (DCA) is effective in shoulder instability with glenoid bone loss. The original technique uses an osteochondral autograft, fixed with screws or suture anchors. We developed a modified procedure called "congruent arc DCA" characterized by (1) use of drilling guides to optimize graft positioning and make the all-arthroscopic procedure safer and reproducible; (2) rotation of the DCA of 90° to reach a congruent arc with its undersurface; (3) fixation of the graft with cortical buttons to simplify its intra-articular passage, avoid hardware problems, and facilitate possible revision surgery; and (4) intraoperative use of a suture tensioner to achieve satisfactory compression of the graft and increase its consolidation...

Background: Glenoid reconstruction with distal tibial allograft (DTA) is a known surgical option for treating recurrent glenohumeral instability with anterior glenoid bone loss; however, biomechanical analysis has yet to determine how graft variability and fixation options alter the torque of screw insertion and load to failure. Hypothesis: It was hypothesized that retention of the lateral cortex of the DTA graft and the presence of a washer with the screw will significantly increase the maximum screw placement torque as well as the load to failure...