Arthroscopic Anatomic Glenoid Reconstruction: Analysis of the Learning Curve

OBJECTIVES: This procedure involves the use of distal tibial bone graft to recreate anterior glenoid bone surface with the goal of preventing further dislocations. Recently, an arthroscopic approach has been proposed for this procedure, which uses a similar technique to the Bankart repair. This approach requires one additional medial portal (4 total), for graft placement, and this is established using an insideout technique; it avoids damage to the subscapularis tendon, and preserves the capsule and labrum. By comparison, the Arthroscopic Latarjet technique requires four additional new portals and requires splitting of the subscapularis tendon, as well as excision of the capsule and labrum. This study seeks to (1) identify a learning curve for this procedure, and (2) compare this to the learning curve for Arthroscopic Latarjet. METHODS: Fiftyseven cases of surgically treated recurrent anterior shoulder instability were reviewed. All operations were carried out with the patient in a lateral decubitus position. Twentynine patients were managed with the Arthroscopic Latarjet procedure using coracoid bone graft, and 28 were treated with Arthroscopic Anatomic Glenoid Reconstruction using distal tibial bone graft. Procedure start and stop times were recorded and procedure durations calculated. RESULTS: In the case of Arthroscopic Latarjet, the first 14 cases took an average 184 minutes to perform, with the remaining cases in the cohort averaging 116 minutes each in duration. For Arthroscopic Anatomical Glenoid Reconstruction, the first 14 cases took an average of 90 minutes, with the remaining cases averaging 84 minutes each. CONCLUSION: Arthroscopic Anatomic Glenoid Reconstruction is faster to perform compared to the Arthroscopic Latarjet. Further investigations into the safety and efficacy of this procedure will help determine whether it is a better choice for surgeons looking to learn the skill of boney augmentation for recurrent anterior instability.