Osteology

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors. Full article