Arthroscopic Anatomical Glenoid Reconstruction Using Iliac Crest Autograft With Double End-Button Fixation Technique

Arthroscopic anatomic glenoid reconstruction is increasingly recognized as an effective surgical technique for addressing significant glenoid bone loss associated with shoulder instability. This technical note provides a step-by-step guide for performing arthroscopic anatomic glenoid reconstruction using an iliac crest autograft with double TightRope end-button fixation (Arthrex, Naples, FL). The procedure is conducted through 3 arthroscopic portals: anteroinferior, anterosuperior, and posterior. Bone tunnels on the glenoid undersurface are created using a Transglenoid Drill Guide (Arthrex). A tricortical autograft measuring 20 mm in length and 10 mm in width is harvested from the ipsilateral iliac crest. Two bone tunnels are prepared in the graft to accommodate 2 TightRope and DogBone constructs (Arthrex). The graft is introduced via the extended anteroinferior portal, passing through a partially dissected rotator interval while the integrity of the subscapularis tendon is preserved. It is then securely fixed to the anterior glenoid rim using double TightRope end-button fixation, with 2 DogBones positioned on the posterior glenoid rim. The procedure is completed with a Bankart repair, fully covering the graft. This all-arthroscopic technique offers several advantages, including minimal invasiveness, avoidance of hardware-related complications, preservation of subscapularis tendon integrity, and reliable bone graft union with the iliac crest autograft.