Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft

Authors:

Peter J Millett, Jean-Yves Schoenahl, Bradley Register, Trevor R Gaskill, Derek F P van Deurzen, Frank Martetschläger

Abstract:

Posterior dislocation of the shoulder is uncommon and represents less than 5 % of all shoulder dislocations [10]. Frequent etiologies include trauma, congenital hyperlaxity, or epileptic seizures. In most cases, only soft tissue damage of the posterior capsulolabral complex occurs. Though less common, posterior glenoid bone loss can occur if the injury is of sufficient magnitude or if recurrent dislocation occurs. Though bone loss greater than 20–25 % of the anterior glenoid is often considered an indication for reconstruction, the magnitude of posterior glenoid bone loss necessary to result in posterior shoulder stability is less clear. Posterior glenoid reconstructive options are limited compared to those available for anterior glenoid bone loss. Specifically, a surrogate for coracoid transfer that accomplishes both bony reconstruction and dynamic stability is not available for the management of posterior glenoid deficiency. Therefore, reconstructive techniques have focused on extra-articular structural bone transfer that obstructs humeral translation and thereby prevents glenohumeral dislocation. These salvage techniques provide satisfactory early outcomes, but more recent literature suggests long-term results are not as promising. Considering these results, a technique capable of restoring both glenoid bone stock and congruent articular cartilage may be beneficial.

Therefore, we describe the use of a distal tibia osteoarticular allograft for treatment of posterior shoulder instability with large posterior glenoid bone defect. The use of fresh distal tibia allograft has previously been described as an anatomic reconstructive option for anterior glenoid bone loss. Its use for posterior glenoid reconstruction has not been described yet. Therefore, this technique provides a new treatment option for patients with recurrent posterior instability accompanied by substantial posterior glenoid bone loss.

For the complete study: Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Reconstruction of posterior glenoid deficiency using distal tibial osteoarticular allograft

Authors:

Abstract:

About the Author: Peter Millett, MD