腸骨稜自家骨移植とダブルエンドボタン固定法を用いた関節鏡視下解剖学的関節窩再建術

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.