Chapter 3 Instability

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CHAPTER 3 | Instability

FIGURE 3-14  Securing the coracoid bone graft. A: Guide wires are inserted through the Parallel Drill Guide (Arthrex, Inc., Naples, FL) to temporarily hold the graft in place. B: The drill guide is removed, and the appropriate screw length can be measured. C: Final appearance of secured graft after placement of two cannulated 3.75-mm screws. The graft is flush with the glenoid articular surface and extends the native glenoid arc. C, coracoid graft; G, glenoid.

#2 FiberWire suture (Arthrex, Inc., Naples, FL). If the tendon stump is of poor quality, then BioComposite CorkScrew FT suture anchors (Arthrex, Inc., Naples, FL) are used. It is not necessary to reattach the pectoralis minor to the residual coracoid base or adjacent soft tissues because it does not retract. We have not observed any residual symp- toms or cosmetic deformity relative to the unrepaired pec- toralis minor. After subscapularis repair, a standard skin closure is performed. Optimizing the Chances of Bone Graft Union The key to obtaining union between the coracoid graft and the anterior glenoid is to have two large flat surfaces that are in intimate contact throughout their surfaces. We believe that the common practice of using a burr to prepare the bone surface, particularly the anterior glenoid neck sur- face, leaves an uneven interface that may not have good contact with the matching surface of the graft. Therefore, we use a saw to create these surfaces to ensure that they are perfectly flat. For the coracoid graft, we have already used a straight sawblade to remove a “wafer” of the bone from the medial side of the graft (i.e., on the side where the pectoralis minor had inserted) (Fig. 3-9B).

any abrasive potential of the graft against the articular car- tilage of the humerus (Fig. 3-15). Subscapularis Repair If a subscapularis split has been used, the upper and lower subscapularis muscle segments will reapproximate themselves once the retractors have been removed, and no sutures are necessary. When the upper subscapularis has been detached and retracted medially during the exposure, it is usually repaired back to its stump with

FIGURE 3-15  Suture anchors are placed at the interface of the graft and the native glenoid arc and used to repair the anterior capsule so that the coracoid graft remains extra-articular.