Arthroscopic Iliac Crest Bone Grafting for Shoulder Glenoid Defect Augmentation Using a "Three-Pulley Four-Point Antirotation" Suture Anchor Technique.

Treatment options for severe glenoid bone defects caused by recurrent anterior shoulder instability include autologous coracoid transfer and bone graft reconstruction. The effect of bone-grafting techniques is satisfactory, and the fixation methods for the bone block include screws or suture buttons. However, problems caused by metal plants and high bone resorption rates are a serious concern. In addition, the current anchor suture fixation technique is prone to unstable fixation and bone block rotation. Therefore, we describe an arthroscopic technique for severe glenoid bone defects that use autologous iliac bone grafting, combined with labrum anchors and pulley knot to fix the bone block, known as the "3-pulley 4-point antirotation suture anchor technique." Four labrum suture anchors are placed on the upper and lower edges of the glenoid defect to form 4 force points (4-point fixation), and the pulley technique is used for knotting to make the fixation more secure and solve the problem of easy rotation.