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Open Posterior Glenoid Reconstruction Using a Distal Tibial Allograft.

Tracy M Tauro¹, Nolan B Condron¹, Ryan J Quigley¹

¹Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.

Video Journal of Sports Medicine

|May 1, 2025

Summary

Posterior distal tibial allograft effectively treats posterior shoulder instability and glenoid bone loss. This surgical technique shows promising results in restoring stability and achieving bony union.

Keywords:

allograft distal tibial allograft glenoid bone loss posterior shoulder instability shoulder instability

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Area of Science:

Orthopedic Surgery
Sports Medicine
Shoulder Reconstruction

Background:

Posterior shoulder instability is less common than anterior instability, often occurring in contact athletes or post-traumatically.
Glenoid bone loss can complicate posterior instability, necessitating reconstructive techniques.
Distal tibial allograft reconstruction for glenoid bone loss was first described in 2009, with arthroscopic techniques evolving since.

Purpose of the Study:

To describe the indications, technique, and outcomes of posterior distal tibial allograft for glenoid bone loss.
To evaluate the efficacy of distal tibial allograft in managing recurrent posterior shoulder instability.
To assess potential complications such as graft nonunion and resorption.

Main Methods:

The procedure involves a lateral decubitus position and arthroscopic evaluation.
An incision is made posterolaterally, splitting the deltoid and between the infraspinatus and teres minor.
A prepared distal tibial allograft is secured to the glenoid using screws after drilling pilot holes.

Main Results:

Studies indicate successful bony union by 6-month CT scans with minimal to no graft resorption.
Patient-reported outcomes show improved stability and function post-surgery.
A high success rate (90%) in restoring shoulder stability has been reported in case series.

Conclusions:

Posterior distal tibial allograft is a successful surgical option for posterior shoulder instability with significant glenoid bone loss.
The technique demonstrates good graft incorporation and restoration of shoulder stability.
It addresses cases of failed conservative management or recurrent instability after prior stabilization.