CORR Insights®: Posterior Open-wedge Osteotomy and Glenoid Concavity Reconstruction Using an Implant-free, J-shaped Iliac Crest Bone Graft in Atraumatic Posterior Instability with Pathologic Glenoid Retroversion and Dysplasia: A Preliminary Report

Posterior instability in patients with increased glenoid retroversion remains a challenging treatment problem. Though posterior instability represents less than 10% [^{10, 11}] of patients with unidirectional instability, and most of these patients will respond well to posterior labral repair and/or capsular imbrication, it is generally felt that shoulders with bony glenoid insufficiency will not be rendered stable with soft tissue stabilization procedures alone, as one recent study again demonstrated [⁶]. Recurrent instability can damage the articular surface, which may cause early arthritis. And among those patients who progress to advanced arthritis and undergo arthroplasty, those procedures are made more challenging because of those glenoid version abnormalities, some of which should be corrected. This adds risk and complexity to a group of patients who already have too much of both, since they’re often younger at the time of the index arthroplasty [^{2, 3}].

Techniques for treating instability in this group of patients include glenoid osteotomy, osteochondral allograft, the reverse Putti-Platt, the McLaughlin procedure and its modifications, staple capsulorrhaphy, thermal capsulorrhaphy, humeral rotational osteotomy, labral repair, and capsular shift. All have their limitations and advantages [^{3, 5, 7, 12}].

In this study, Ernstbrunner and colleagues [⁴] present the results of a novel technique using a “J”-shaped iliac crest graft inserted into a posterior glenoid osteotomy. It is similar to the technique described for anterior instability and modifies the traditional Scott osteotomy to use the J-shaped graft, which also helps restore the glenoid concavity and does not employ hardware. The technique is clever and offers the potential advantage of restoring the glenoid concavity without implants, which saves expense and potential hardware complications, and it may help to preserve the joint surfaces. It may also slow the development of degenerative disease.