ARTHROSCOPIC TECHNIQUE OF BONE AUTOGRAFTING OF GLENOID CAVITY DEFECTS IN PATIENTS WITH RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER

Abstract

Injuries of the bone anterior edge of the glenoid cavity of scapula is noted in 90% of patients with recurrent shoulder instability and it is the cause of recurrent dislocation in 67% of cases. The authors have presented a description of techniques and benefits of arthroscopic autoplasty (autografting) of scapula glenoid. A total of 10 operations were performed in 9 men and 1 woman. The average age of operated patients was 27,1±4,7 years. All patients were injured during contact sports. In the preoperative and immediate postoperative period computer tomography of damaged shoulder was performed in all patients with reconstruction in 3D images. The size of the bone defect was evaluated by 3D scans and averaged 29.7%. During the first stage free bicortical grafts with varying sizes from the wing of the ilium were harvested. Preartroscopic stage permits to avoid swelling of paraarticular structures during arthroscopy and allows to correct positioning and fixation autografts in the joint. The arthroscopic signs of defect and the technique of immersing of previously prepared free fragment through a wide 10 mm cannula and subsequent minimally invasive fixation with cannulated screws in scapula neck were described. This operation is an alternative to the transposition of coracoid process, does not require special tools and a long operating time (average 60-80 min), excludes injuries of brachial plexus branches and surgical trauma of subscapularis muscle, does not disturb the normal anatomy of the shoulder joint. There were no neurological complications, recurrences of instability in the immediate postoperative period.

Keywords

• нестабильность плечевого сустава
• суставная впадина лопатки
• артроскопическая аутопластика
• instability of the shoulder joint
• the glenoid cavity of scapula
• arthroscopic autoplasty