Shoulder joint is the largest and most flexible joint of upper limb. The humeral head is large, and the glenoid is small. The joint is prone to instability, while it has a large range of motion.The most common case is anterior shoulder instability, and its incidence rate is up to 2%. In traumatic anterior shoulder instability, Bankart injury is the most common pathological change, which accounts for 4%-70% in anterior shoulder dislocation.Small bone defect generally has little effect on the stability of shoulder joint. However, with the increasing number of dislocations, the area of ??bone defect increases, and the risk of joint instability is growing. It is reported that the recurrence rate is up to 67% after arthroscopic Bankart repair surgery for the treatment of shoulder dislocation with giant bone defect. Therefore,the domestic and foreign experts believe that osseousreconstruction is necessary when the bone defect is greater than 20%-25% of the long axis of glenoid.The bone graft reconstruction is recommended when the case is combined with Hill-sachs injury. However, the current methods of bone reconstruction are still inconclusive.The previous method for the treatment of anterior glenoid bone defect was Latarjet procedure. However, this surgery requires the removal and transfer of coracoid process to glenoid for bone reconstruction. It destroys the anatomical structure around shoulder joint and has great influence on shoulder function. Another method is anterior glenoid bone grafting. This procedure is simple with minimal trauma, and it does not destroy the original structure of shoulder joint. Currently, the absorption of bone graft and the recovery of patient after anterior glenoid bone grafting are rarely reported. Objective To explore the clinical efficacy and radiological result of arthroscopic glenoid reconstructionwithautogenous iliac bone graft for the treatment of recurrent anterior shoulder dislocation with severe bone defect.

From January 2016 to December 2018, the patients with recurrent anterior shoulder dislocation with severe bone defect were treated by total arthroscopic glenoid reconstruction with autogenous iliac bone graftin our hospital, and the data was retrospectivelyanalyzed. A total of 30 patients (23 males and 7 females) received complete follow up, including 11 left shoulders and 19 right shoulders.The average age was 49.45 years (17-77 years) .The number of dislocations before operation was 7-104 times.All patients underwent arthroscopicglenoid reconstruction with autologous iliac bone graft.The positions of bone graft were evaluated by CT scan and three-dimensional reconstruction after operation.The function and stability of shoulder joint were evaluated by ASES, Constant-Murley, Rowe and VAS scoring systems, and active range of motion was applied in theassessment of shoulder function and stability during follow up.

All patients were followed up for 6-28 months with an average of (17.67±10.17) months.No complication such as incision infection, hemorrhage, redislocation, etc. occurred. During the preoperative and last followups: the average ranges of anteflexionwere (146.13±43.43) °and (163.23±13.21) °; the average ranges of internal rotation werein level T7 and T8; the average ranges of external rotation were (53.91±8.60) °and (58.91±3.63) °; the average ranges of external rotation in 90°abduction were (87.32±5.54) °and (88.12±6.12) °. There were significant differencesbetween the preoperative and last followupsinanteflexion andexternal rotation (P<0.05) , while there wasno significant differencebetween the preoperative and last followups in internal rotation and external rotationin 90° abduction (P>0.05) .The ASES scores during the preoperative and last follow-upswere (71.32±18.12) points and (93.45±7.87) points, respectively (P<0.05) .The Constant-Murley scores during the preoperative and last follow-ups were (82.54±15.31) points and (92.52±7.67) points, respectively (P<0.05) . The Rowe scores during the preoperative and last follow-ups were (39.56±6.75) points and (94.23±7.23) points, respectively (P<0.05) . There were statistical differences between the scores during the preoperative and last follow-ups (P<0.05) . With 4:30 as the center of fragment in three-dimensional CT reconstruction during the last follow up, there were 26 casesof good position, 2 cases of higher position and 2 cases of lower position. With the assessment conducted with the cross-sectional CT scan aligned to the level of glenoid, there were 28 cases of good position, 1 case of medial position and 1 case of lateral position.All patients returned to activity without dislocation or instability.

The arthroscopic glenoid reconstruction with autogenous iliac bone graft is an effective method for the treatment of recurrent anterior shoulder dislocation with severe bone defect. The operation of arthroscopic iliac bone graft is simple and safe, which is the ultimate solution for recurrent anterior shoulder dislocation.