Recurrent anterior glenohumeral instability and particularly failed surgical repairs may be complicated by loss of anterior glenoid concavity. Patients with major defects of the anteroinferior glenoid are unlikely to respond to soft-tissue procedures alone. In these situations a bony reconstruction is considered. Extracapsular anatomically contoured anterior glenoid bone grafting, using autologous iliac crest, provides an excellent method of robustly reconstructing the anterior glenoid lip. The iliac crest bone graft is secured so that the capsule is interposed between it and the humeral head. The graft is contoured so that it extends the natural curvature of the glenoid. Immediate stability provided by the securely fixed graft allows motion to be started the day of surgery. This procedure has provided secure glenohumeral stability in situations where soft-tissue repairs proved inadequate. It is our procedure of choice when the anterior glenoid lip cannot be reconstructed by soft-tissue procedures.
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