Arthroscopic Management of Anterior Glenoid Bone Loss

Anterior glenohumeral instability is a complex problem that requires careful attention to osseous and soft-tissue lesions in order to treat it effectively. The arthroscopic soft-tissue Bankart repair is considered first-line treatment for patients with anterior glenohumeral instability. However, recent long-term outcome studies have shown surprisingly high failure rates, specifically in the setting of anterior glenoid bone loss. The definition of "critical" glenoid bone loss that cannot be overcome by a soft-tissue procedure alone continues to evolve and may in fact be lower than the previously published total of 20%. Arthroscopic reconstruction of the anterior glenoid margin can be performed with either autograft or allograft. The arthroscopic Latarjet procedure has emerged as a reliable and effective technique for autograft augmentation, while the distal aspect of the tibia appears to be a promising source of allograft.