Table 1.

Pearls and Pitfalls

Pearls	Pitfalls
Use an arm positioner that is placed at the head of the bed.	When cleaning out the rotator interval and removing part of the coracoacromial ligament, be careful not to remove the medial sling of the biceps because this can lead to medial biceps instability.
Drape out the entire shoulder quarter to prevent contamination of the K-wire once it penetrates the skin posteriorly.	Burr circumferentially around the proximal coracoid prior to osteotomy to prevent fracture propagation into the scapular body.
Medialize portal A (posterior portal) slightly to aid in localization of the subscapularis split; this allows a co-plane relation to the glenoid.	Once provisional fixation of the graft is complete, tighten the screws in alternating fashion so as not to malposition or fracture the graft.
Clamp the K-wire once it is drilled out of the posterior shoulder to prevent retrograde advancement back into the shoulder.	Take care when visualizing the neurologic structures (i.e., axillary and musculocutaneous nerves) to avoid injury.
Decorticate the anterior glenoid and inferior coracoid to assist in bony healing.	Bear in mind that it is important to have a clean bony bed for the graft and confirm no soft-tissue interposition is preventing graft healing.