Arthroscopic distal clavicle autograft with suture button fixation for shoulder instability with glenoid bone loss: a case series

Purpose Distal clavicle autograft (DCA) has garnered increasing popularity as a cost-effective and safe autograft for glenoid reconstruction in shoulder instability The purpose of this study is to report the clinical outcomes of a single-surgeon case series of patients managed with arthroscopic DCA for glenoid bone loss with suture button fixation at minimum follow-up of one year. Methods All cases of recurrent anterior glenohumeral instability treated with DCA by a single surgeon between January 2020 and December 2023 were reviewed. Patients were included if DCA was performed arthroscopically with two suture buttons for fixation, with minimum clinical follow-up of one year. Patients were evaluated postoperatively for recurrent instability or complications. Glenoid bone loss was measured using 3-dimensional reconstruction and best-fit circle methods on preoperative computed tomography scans. Coracoclavicular (CC) distances were measured pre- and postoperatively to assess for acromioclavicular joint instability and change in pre- to postoperative CC distance was assessed with dependent t-test. Results Eight patients were included. Average age was 32.6 years. There were seven males and one female. At surgery, mean glenoid bone loss was 23.3% (range: 17.8%-30.8%). At harvest, the average length, thickness, and width of the distal clavicle autograft were 22.8mm, 11.6mm, and 11.3mm, respectively. After preparation, the graft averaged 22.8mm in length with a width and depth of 10mm, respectively. At a mean follow-up of 2.6 years (range 1.5-4.0 years), no patients had recurrent subluxation or dislocation. No evidence of CC ligament damage was noted; average pre and postoperative CC distances were 11.5mm and 11.3mm, respectively, with mean change of –0.7 mm (95% CI: –4.8 to +3.4 mm, p=0.69). One patient was noted to have one loose posterior extracapsular button without clinical complication. No other complications were noted. Conclusion In this case series of patients who underwent arthroscopic glenoid reconstruction with DCA, we noted low complication rates and no evidence of recurrent instability.