Arthroscopic Posterior Bone Block Procedure With Two Cortical Buttons Fixation and Specific Glenoid Guide for Posterior Shoulder Instability

Arthroscopic posterior bone block procedure using cortical screws has been reported since 2012 for management of recurrent posterior instability associated with bone defects. To avoid screw complications, we describe a full arthroscopic technique based on cortical button fixation. With 4 portals (posterior, poster lateral, anterior, and antero-lateral), we use a specific glenoid guiding system (to perform 2 tunnels) and 2 cortical buttons fixation. With a specific glenoid guide, the iliac crest bone graft (ICBG) is secured to the posterior glenoid rim by fixation with 2 cortical buttons. The ICBG is positioned protruding outside the joint through the space, and the posterior capsule is repaired while maintaining an extra-articular bone graft. The protruding bone graft increases the concavity of the glenoid with a progressive bony remodeling to improve the posterior stability of the shoulder in our clinical experience.