Table 3.

Step-by-Step Surgical Technique Guide

1	Place a 30° arthroscope in anterior superior portal for viewing. Address all intra-articular pathology first prior to proceeding with the all-arthroscopic posterior glenoid reconstruction.
2	Prepare posterior glenoid with radiofrequency ablator or device to debride the scar tissue, capsule and any remining tissue off the glenoid neck at least 1cm medial to the glenoid surface. A vertical capsulotomy is created to allow passage of the graft.
3	Arthroscopic burr to create flat bleeding bony surface on posterior glenoid neck
4	Make a 3-cm posterior skin incision just medial (1-2 cm) to the original posterior portal.
5	Blunt dissection to spread the posterior deltoid and underlying soft-tissue with either blunt instrument or manually with your finger tip. Make sure enough tissue is cleared to allow the graft to be flush to the posterior glenoid neck.
6	Insert a switching stick from posterior portal or from the mini-incision flush to the glenoid to the anterior chest wall. Use switching stick from anterior to make sure the graft is flush and also used the stick to lift up the posterior capsule to help passage of the graft.
7	Use arthroscopic measuring device to size the length of the glenoid defect. Typically the length is between 2 and 2.5cm in size.
8	Fresh distal tibia allograft opened on the back surgical table and soak in BAN solution for 5 minutes.
9	Cut allograft to size with microsagittal saw to create 2 flush surfaces about 1cm in width and 1 cm in depth. Pulse-lavage allograft for several minutes and orthobiologics can be added if desired.
10	Secure allograft to Mitek arthroscopic Latarjet set using 2 pins followed by tap and top hat on both sides
11	The Coracoid guide placed flush to the graft with 2 k-wires inserted into the alpha and beta holes. The Coracoid step drill is used and then each hole is also tapped. Two Top Hats are placed into the graft.
12	The Coracoid double cannula is used with the long 3.5-mm Coracoid screws over the Top Hats to secure the distal tibia allograft.
13	The graft is passed from the posterior mini-incision into the shoulder joint and to the back of the glenoid rim.
14	Arthroscopic confirmation of articular congruence of the allograft and native glenoid surface via a switching stick from the front.
15	Two k-wires are inserted into the cannulated long 3.5mm screws via the double Coracoid cannula holder to provisionally secure the graft to the glenoid neck.
16	One of the long 3.5mm Coracoid screws is taken out and a 3.2-mm cannulated drill bit is used via the k-wire to drill to the anterior glenoid neck.
17	The drill hole is measured and the first 4.5-mm partially threaded screw is inserted to compress the graft down. Same step is repeated and secure the allograft to the glenoid via two screws placed parallel to the articular surface.
18	Alternative tightening of each screw is important to maximally compress the allograft down to the posterior glenoid neck.
19	Remove cannulas and insert switching stick to check articular congruence.
20	Once confirmed, remove all instrumentation from the glenohumeral joint.
21	Incisions closed with absorbable sutures and the arm is placed in a sling and abduction brace.