Treating Recurrent Anterior Glenohumeral Instability Using an Autogenous Tricortical Iliac-Crest Bone Graft: Eden-Hybbinette Procedure

Abstract

Traumatic anterior instability is one of the most commonly diagnosed and treated conditions of the shoulder and is often associated with bone loss from the glenoid, the humerus, or both. It is recognized that bony defects of the anterior glenoid are common among shoulders with recurrent instability [1], [2]. A significant glenoid bone defect limits the effectiveness of arthroscopic repair of anteroinferior shoulder instability [3]. The critical size of the defect above which an arthroscopic Bankart repair becomes ineffective has been estimated by Itoi et al. [4] to be an average width of 6.8 mm, or 21% of the glenoid length. In defects of this size, the translational force required to subluxate the humeral head in abduction and external rotation is significantly decreased. If a critical bony glenoid defect is not addressed along with arthroscopic capsulolabral refixation, the risk of redislocation is increased, resulting in recurrence rates reported to range from 56% to 67% [4]. Yamamoto et al. confirmed that an osseous defect width 19% of the glenoid length remains unstable even after Bankart-lesion repair [5].