Arthroscopic Endobutton bone block stabilisation of shoulder with iliac crest graft (Smith and Nephew) surgical technique
Subscribe to get full access to this operation and the extensive Shoulder & Elbow Surgery Atlas.
Learn the Arthroscopic Endobutton bone block stabilisation of shoulder with iliac crest graft (Smith and Nephew) surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Arthroscopic Endobutton bone block stabilisation of shoulder with iliac crest graft (Smith and Nephew) surgical procedure.
Soft tissue stabilisation of antero-inferior gleno-humeral joint instability is, in general, a reliable and reproducible procedure. Anterior instability is however associated with a degree of bone loss in approximately 90% of cases. In the face of significant bone loss (defined broadly as anything around or more than 20% of the bone stock) the rate of recurrence following soft tissue stabilisation may increase dramatically to as much as 70% if using a standard arthroscopic Bankart type repair.
Open bone transfer procedures such as the Latarjet or Eden Hybinette have been shown to improve outcome and reduce redislocation rates in the presence of significant bone loss. Since La Fosse et al first described their arthroscopic Latarjet technique in 2007, there has been increasing interest over many years in arthroscopic bone procedures.
Whilst the Latarjet procedure may provide some dynamic stability from the conjoint tendon sling, there is reasonable concern regarding the associated complication rate (up to 30%) and the potential long-term compromise of the Subscapularis.
The use of an iliac crest bone block passed through the rotator interval may avoid such concerns and a number of arthroscopic iliac bone block procedures have been described and reported. The fixation for most of these techniques utilises a suture-pulley and button system.
The following guide illustrates a technique using the Smith and Nephew Endobutton implant but is largely consistent with most of the suture-pulley and button systems available.
The arthroscopic bone block stabilisation is my preferred surgical technique for addressing significant bone loss in those not undertaking high risk activities or contact sports, allowing the bone defect to be addressed with a lower risk profile and the avoidance of compromise to the subscapularis.
In the high-level competitive contact athlete I prefer an open modified (congruent arc) Latarjet.
The following technique is in line with that described by Professor Ettore Taverna.
Author: Mr Iain Packham FRCS (Tr & Orth)
Institution: The Avon Orthopaedic centre, Southmead hospital, Bristol, UK.
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.