Editorial Commentary: Open Distal Tibial Allograft With Screw Fixation for Distal Tibial Allograft Glenoid Reconstruction in Patients With Shoulder Instability May Result in Lower Recurrence Rates Than Button Fixation

Abstract

The glenoid rim is altered in up to 90% of shoulders with recurrent instability. Distal tibial allograft, an option for anatomic glenoid reconstruction (AGR), has excellent midterm outcomes and low recurrence and resorption rates using open or arthroscopic technique. Optimal graft position in both the medial-lateral and vertical axes, adequate fixation, and restoration of soft-tissue balance is the key to successful outcomes. Regarding fixation methods, metal screw fixation is a standard for AGR with free bone block or Latarjet procedure. The main disadvantage of screw fixation is hardware prominence and irritation to surrounding bone and soft tissue (6.5%), the leading cause of revision surgery. Button fixation may mitigate hardware complications but lead to greater graft malposition, resorption, and recurrence rates. The authors used an open approach with screw fixation for AGR with distal tibial allograft and restoration of the capsulolabral complex to reduce recurrent instability after surgery.