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CURRENT CONCEPTS

Recurrent Anterior Shoulder Instability Decision Making and Discussion:

with Glenoid Bone Loss and Subscapularis This case illustrates a successful, novel treatment of complex
Insufficiency: Successful Surgical Treatment recurrent anterior shoulder instability with critical glenoid

With Distal Tibia Allograft and Split Pectoralis bone loss and subscapularis insufficiency, a particular clinical
Major Tendon Transfer
situation that to our knowledge has yet to be reported in the

currently available literature. Though limited to a single case
CT arthrogram performed 7months post operatively in this setting, we anticipate that with heightened awareness,
demonstrated anatomic restoration of the glenoid contour with
this may be more frequently encountered in the future.
healing of the distal tibia allograft and excellent integrity of her
pectoralis transfer.(Figure 7) At most recent follow up, 1 year In the current case, it was felt that reconstruction of the
from surgery, the patient demonstrated return of full ROM and
glenoid bone loss was of paramount importance and thus
full strength with no recurrence of instability. Pain was rated consideration was given first to bony glenoid reconstruction.
at 1-2/10 with a subjective shoulder value of 90%, stating Our procedure of choice in this setting is typically an

she was “very happy she had surgery”. She demonstrated autologous transfer of the coracoid to the anterior glenoid
no cosmetic deformity of her chest in the region of pectoralis (Latarjet procedure). However, part of the success of the

harvest and had normalization of her previous hyper-external Laterjet procedure hinges on the “sling effect” of the conjoined
rotation and now a symmetric belly press and absence of tendon and the inferior half of the subscapularis. In the

apprehension/relocation.(Figure 8)
absence of a functional subscapularis, the advantage of the
“sling effect” was lost. Additionally, in a young patient with

several failed surgical procedures, there was concern that she
may require additional interventions, possibly for arthroplasty,

at some point in the future and this would be complicated by
the distortion in the native anatomy created by the Laterjet
procedure. Thus, free iliac crest autograft and allograft options

were presented to the patient and she wished to proceed with
allograft reconstruction. Distal tibia allograft was chosen due

to the recent reports of its excellent articular congruency and
graft availability.

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32 ISAKOS NEWSLETTER 2013: Volume II