Glenoid Bone Loss

Traumatic glenohumeral dislocation or chronic glenohumeral dislocation/subluxation can cause damage to or fracture the glenoid rim. The resulting bone loss leads to instability that cannot be corrected with soft-tissue/labral repair alone. Common reconstructive techniques include Latarjet or glenoid augmentation using free bone block grafts, such as iliac crest or distal tibia. The increase in bone surface area leads to a stabilized glenohumeral joint. Arthrex offers a portfolio of instruments and fixation devices to accommodate a wide range of glenoid bone loss techniques.

Bone Block Cerclage

Bone block cerclage is an innovative arthroscopic surgical technique that preserves the integrity of the subscapularis and provides a metal-free fixation of the bone graft.¹ Two interconnected FiberTape® and TigerTape™ cerclage sutures provide firm compression of the graft and strong fixation that minimizes construct displacement at high loads.^2,3
The FiberTape Cerclage for Glenoid Bone Loss Implant System contains all the necessary implants and disposables for the procedure (except capsulolabral repair anchors). To help provide a reproducible surgical technique, the kit includes an arthroscopic measuring probe, two 3-mm cannulated drills of different lengths to facilitate unobstructed drilling, and the MegaLoader suture-passing loop to aid in the passage of sutures into instruments and bone grafts.
_References
_{1. Hachem AI, Del Carmen M, Verdalet I, Rius J. Arthroscopic bone block cerclage: a fixation method for glenoid bone loss reconstruction without metal implants.}_{Arthrosc Tech.}_{2019;8(12):e1591-e1597. doi:10.1016/j.eats.2019.08.014}
_{2. Arthrex, Inc. LA1-000140-en-US_A. Naples, FL; 2024}
_{3. Ritter D, Hachem AI, Scheibel M, et al. Primary stability and bone contact loading evaluation of suture and screw based coracoid graft

fixation for anterior glenoid bone loss.}_{Am J Sports Med}_{. 2023;51(11):2858-2868. doi:10.1177/03635465231188976}

Congruent Arc Latarjet

The Glenoid Bone Loss Set includes unique instrumentation and implants to make the open Latarjet technique more consistent and repeatable. The Congruent Arc Latarjet Technique involves dissecting the coracoacromial ligament and pectoralis minor from the coracoid and performing a coracoid osteotomy. A grasping coracoid drill guide is used to prepare two parallel holes in the coracoid graft, which then mate with one of the glenoid parallel drill guides. The cannulated guide allows the graft to be positioned on the glenoid, while guidewires are placed through the graft and into the glenoid. Self-drilling, self-tapping 3.75 mm titanium cannulated screws are then placed over the guidewires to secure the graft into position.

Distal Tibia Allograft Workstation for Glenoid Bone Loss

Treatment of shoulder instability due to glenoid bone loss can be challenging. Common reconstructive techniques include the Latarjet procedure (coracoid transfer) or glenoid augmentation using autograft iliac crest or allograft distal tibia allograft (DTA).¹ The lateral portion of the distal tibia is a great match to the patient’s glenoid because it has similar curvature, dense bone, and cartilage.
The Distal Tibia Allograft Workstation allows the surgeon to use trials to determine the desired size and shape of the bone block for use with Bone Block Cerclage or the Glenoid Bone Loss Set. A set of simple cutting guides are then used to precisely machine the DTA to match the trial for the procedure.
^Reference
^{1. Provencher MT, Ghodadra N, LeClere L, Solomon DJ, Romeo AA. Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft.}^Arthroscopy^{. 2009;25(4):446-452. doi:10.1016/j.arthro.2008.10.01}