• Pei-Wei Weng, Hsain-Chung Shen, Hsieh-Hsing Lee, Shing-Sheng Wu, and Chian-Her Lee.
• Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
• Am J Sports Med. 2009 Sep 1; 37 (9): 1792-7.

BackgroundSevere glenoid bone loss in recurrent anterior glenohumeral instability is rare and difficult to treat.PurposeThe authors present a surgical technique using allogeneic bone grafting for open anatomic glenoid reconstruction in addition to the capsular shift procedure.Study DesignCase series; Level of evidence, 4.MethodsNine consecutive patients with a history of recurrent anterior shoulder instability underwent reconstruction of large bony glenoid erosion with a femoral head allograft combined with an anteroinferior capsular shift procedure. Preoperative computed tomographic and arthroscopic evaluation was performed to confirm a > or =120 degrees osseous defect of the anteroinferior quadrant of the glenoid cavity, which had an "inverted-pear" appearance. Patients were followed for at least 4.5 years (range, 4.5-14). Serial postoperative radiographs were evaluated. Functional outcomes were assessed using Rowe scores.ResultsAll grafts showed bony union within 6 months after surgery. The mean Rowe score improved to 84 from a preoperative score of 24. The mean loss of external rotation was 7 degrees compared with the normal shoulder. One subluxation and 1 dislocation occurred after grand mal seizures during follow-up. These 2 patients regained shoulder stability after closed reduction. The remaining patients did not report recurrent instability. All patients resumed daily activities without restricted motion.ConclusionThis technique for open reconstruction is viable for the treatment of recurrent anterior glenohumeral instability with large bony glenoid erosion.

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