Table 1.

Surgical Pearls and Pitfalls

Pearls

The surgeon should use a guide pin into the glenoid defect to establish the access angle (α). In addition, he or she should use a cannulated acorn reamer over the guide pin to maintain consistency of the angle.

After harvest, Alloplug backfill plugs (Arthrex) should be used to fill the defect created from harvesting the autograft. The plugs should be trimmed with a rongeur or with Mayo scissors before insertion to match the cartilage angle. The backfill plug should be recessed approximately 1 mm to safely avoid any prominences.

The portals should be made large enough to insert the graft easily with minimal resistance. Large portals through the rotator cuff should be made longitudinally along the fibers and closed in a side-to-side manner at the conclusion of the procedure.

The surgeon should establish and verify the position and orientation of the graft arthroscopically before insertion into the recipient site. If a graft plug is malpositioned or inserted in an undesirable location, the plug can be removed with a removal device (Arthrex) from the disposable osteochondral autograft transfer kit and the procedure repeated with another graft.

Repair of any labral pathology should be postponed until after the insertion of the graft (or grafts) because maximum humeral mobility is desired for site preparation and graft insertion.

Pitfalls

If the osteochondral lesion is situated on the rim of the glenoid, reaming perpendicular to the glenoid face may seem desirable; however, this may result in the reamer perforating the glenoid neck. Therefore, intentionally angling the reamer may be necessary to avoid this pitfall.

When positioning the patient, one should be sure to leave the ipsilateral knee well exposed so that it can be prepared and draped in preparation for the graft harvest.

The surgeon must ensure that the orientation of the graft is correct before insertion into the recipient site. Once the graft has been inserted, it is difficult to change the orientation of the graft. Use of a clear graft delivery tube (Arthrex) is critical to determine graft orientation before insertion. If the graft is inserted incorrectly, it must be removed and another graft placed.