Open Distal Tibial Allograft Augmentation

Isolated soft tissue stabilization procedures for treatment of recurrent shoulder instability are often not appropriate when the patient demonstrates bone loss of greater than 15% and in situations where there is recurrent instability after multiple attempts at arthroscopic stabilization. Current techniques for glenoid reconstruction include autografts with coracoid transfers, both Latarjet and Bristow techniques, autografts from the iliac crest, and allografts. Recent focus is on the use of distal tibial allografts for glenoid reconstruction. Distal tibial allografts provide a nearly identical radius of curvature to the glenoid with the addition of a thick cartilaginous surface that helps to restore the natural arc of the glenoid, ultimately leading to improved contact pressures by increasing the contact area. Additionally, these grafts are readily available and offer exceptional bone strength for fixation with a screw. This article discusses the surgical technique of distal tibial allograft augmentation for recurrent shoulder instability as well as the pre- and postoperative management of these patients.