Table 2.
Pearls and Pitfalls
| Pearls | Pitfalls |
|---|---|
| Beach chair with use of articulating pneumatic arm-holder allows for maneuverability of the shoulder | Failure to sufficiently remove posterior labrum and capsule will inhibit graft insertion and fixation |
| The shoulder must be prepped out very medially to allow the posterior incision and passage of the switching stick anteriorly to the chest wall | |
| The posterior mini-incision for the allograft must be made 1 to 2 cm medial to the posterior portal to allow the graft to sit flush on the glenoid neck | |
| Meticulous graft preparation is vital to allow for the success of each additional step | Undersized graft may contribute to inappropriate surface and articular congruence |
| Typical graft size is 2.0 to 2.5 cm in length, 1cm in width and depth | |
| Using the Top Hats and the double Coracoid cannula will allow excellent fixation of the graft and facilitate passage into the joint | |
| Careful preparation of posterior glenoid neck to a flat surface and at least 1 cm over medially from the glenoid fossa to encourage maximum osseous integration and stability of the graft fixation | Failure to address concomitant intra-articular pathology may negatively impact outcomes |
| Arthroscopic posterior vertical capsulotomy is created with a radiofrequency device to allow passage of the graft | |
| Use of blunt instrument or manually with one fingertip to open the posterior soft tissue and increase ease of intraarticular graft passage across the soft-tissues | |
| With a switching stick anteriorly, lift up the posterior opening to allow better passage of the graft | |
| Assure desired articular congruence with the switching stick in the front prior to screw fixation via anterior superior viewing with 30 degrees scope | |
| When drilling posterior to anterior, do NOT plunge the drill bit to avoid neurovascular damage | |
| When the graft is flush to the glenoid surface, place 2 k-wires via the double Coracoid cannula to hold the graft in position | |
| Do not over tighten the first 4.5-mm partially threaded screw to allow rotation of the graft in case it is not flush to the glenoid surface. | |
| When tightening the two 4.5-mm screws, alternate tightening to ensure maximal compression of the graft to the glenoid neck |