Periarticular Glenoid Osteotomy for Posterior Shoulder Instability Using Femoral Head Allograft

Introduction: A periarticular glenoid osteotomy can be used to address recurrent posterior shoulder instability (PSI) that has failed nonoperative interventions. Historically, this technique involves the use of a bone autograft from either the iliac crest, acromion, or scapular spine without internal fixation. Here, we describe a technique using a femoral head allograft with internal fixation. Methods: In a series of 4 patients with recurrent PSI, 5 glenoid osteotomies were performed using a lateral column approach to the glenoid. Osteotomies were performed with a combination of oscillating saw and osteotomes, allowing the articular surface to be “booked” open. Femoral head allograft wedges were cut and inserted, subsequently stabilizing the construct with a 2.7 mm plate. The degree of correction was measured postoperatively with computerized tomography and compared with historically published data. A predictive linear regression model was then created to correlate the size of the wedge and the degree of correction. Postoperative clinical outcomes were also recorded. Results: In the 5 shoulders included, the mean correction of glenoid retroversion was 18.14 degrees, which was statistically significant compared with preoperative retroversion ( P =0.0124). Correction of the version with this technique was comparable to previously published literature. Conclusion: Our described technique provides comparable correction for glenoid retroversion without having to use an autograft. Osteotomy union was achieved in all 5 cases with good functional outcomes.