Arthroscopic bone block procedures for shoulder stabilization

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The arthroscopic Bankart procedure can be very successful in preventing recurrent shoulder instability and has a low complication rate.
However, even if the surgeon masters this procedure, there are cases where the success is limited. Besides patients who have true recurrence of instability, some others remain with «shoulder apprehension», while others abandon their sport in the months or years following the procedure. Those are mainly cases with bony lesions, mostly of the glenoid, and to a lesser degree, of the humeral head.
Glenoid deficiencies are becoming increasingly recognized in patients with anterior recurrent instability.
In these cases, open bone block stabilization using the coracoid process (Bristow, Latarjet) or an iliac crest bone graft (Eden-Hybbinette) are regarded as the «gold standard». Criticism against the arthroscopic bone block procedures is based on reports of complications and failures. It is true that performing an arthroscopic Latarjet can be very dangerous if the surgeon does not master all details perfectly. The use of screws has also been associated most of the complications reported. On the other hand, nothing will stop the development of arthroscopic shoulder surgery. This is why, for more than fifteen years we have been working on the development of arthroscopic techniques that would be safe, reproducible, and using a means of fixation other than screws to fix the bone block on the glenoid neck.
This Arthroscopic Shoulder Manual has been written to be a guide for surgeons whose goal is to master these safe arthroscopic techniques.