Arthroscopic Anterior Glenoid Reconstruction Using a Distal Tibial Allograft Positioned With an Intra-Articular Guide and Secured With Double-Button Fixation

Recurrent shoulder instability and its role in bone loss from the anterior glenoid is well recognized throughout the literature. This technique paper presents an all-arthroscopic technique that uses distal tibial allograft and double-button suture fixation to address anterior recurrent shoulder instability. With the patient in the lateral decubitus position, we use the posterior portal to position the double-barrel drill guide tangential to the face of the glenoid, while viewing through the anterosuperolateral portal. We then use the “bullets,” which are made through two percutaneous posterior skin incisions of the double-barreled drill. This guide ensures parallel drill tunnels are created 5 mm medial to the glenoid articular surface and 1 cm apart, minimizing risk to the suprascapular nerve caused by a straying medial. We prepare a bone block from allograft distal tibia and place two drill holes to match those drilled in the glenoid vault. The allograft is then shuttled arthroscopically using looped passing wires. Once the final position is confirmed, a tensiometer is used to tension the graft in place. We then reattach the labrum to the native glenoid rim. Our technique creates a reproducible, anatomic, glenoid surface reconstruction for anterior glenoid bone loss in recurrent instability.