Abstract
Surgical Technique
Patient Positioning and Anesthesia
Objective Diagnosis
Operative Technique






Advantages |
The glenoid retroversion can be corrected without the need for allograft or donor-site morbidity. |
The measurements can be performed preoperatively, and a 3-dimensional model in the operating room ensures the correct size of the graft. |
Disadvantages |
The procedure is technically demanding. |
A 3-dimensional glenoid model adds cost to the procedure. |
Pearls |
Intraoperative measurements of the glenoid should be used for autograft preparation because preoperative measurements are more prone to error. |
The assistant must provide saline solution irrigation while preparing the graft to avoid thermal necrosis. |
Using a glenoid 3-dimensional model allows for a better understanding of optimal graft placement and reduces surgical time. |
Two K-wires should be used to transfer the graft into the native glenoid. |
Compression screws should be used to fix the graft into the native glenoid. |
Pitfalls |
A graft of the wrong size can jeopardize the procedure because it will not properly correct the severe glenoid retroversion. |
A fracture of the graft may occur if graft preparation is not performed carefully. |
A greater amount of surgical time is possible without the use of a glenoid 3-dimensional model. |
Postoperative Rehabilitation
Discussion

Supplementary Data
- Video 1
The patient is placed in the supine position on the operating table with the left shoulder draped and prepared in standard fashion. The procedure begins with a standard deltopectoral approach. The cephalic vein is carefully identified and mobilized laterally. The clavipectoral fascia is incised proximally to the coracoid. The lateral border of the subscapularis tendon is identified just medial to the bicipital groove and carefully dissected from the underlying capsule. The shoulder joint is accessed. An electrocautery device is used to make a mark at the 135° angle of the humeral head. The cut at this position is subsequently performed with an oscillating saw. After this, attention is turned to glenoid preparation. Measurements are made in the native glenoid with a surgical ruler. The humeral head autograft is prepared according to these measurements. Once the humeral head autograft has been formed, two 0.057 K-wires are drilled into the humeral head autograft for transportation and provisional fixation of the graft. Once provisionally fixed, compression screws (3.0-mm titanium headless compression screws; Arthrex) are used to fix the autograft in place. After fixation of the autograft, the baseplate and glenosphere (Univers Revers) are placed on top of the glenoid and humeral head autograft. The humeral stem broach is then removed. Trial components and reduction are performed to assess stability and range of motion. There should be no impingement at full adduction or full internal rotation, as well as no liftoff at 60° of external rotation and no shuck inferiorly. The final humeral stem, cup, spacer, and liner are then implanted. After this, the wound is thoroughly irrigated and the subscapularis tendon is repaired with the shoulder in approximately 40° of external rotation. Last, standard layered closure is performed.
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References
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Footnotes
The authors report the following potential conflict of interest or source of funding: M.T.P. receives support from Arthrex, JRF Ortho. Consultant. Patent numbers (issued) 9226743, 20150164498, 20150150594, 20110040339. Arthrex, SLACK. Publishing royalties. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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