The anesthesia used was the interscalene block associated with general anesthesia. The positioning used was the horizontal dorsal decubitus with the dorsum elevated at about 30°. Antibiotic prophylaxis with Cefazolin 2 g from 8 to 8 h, for a period of 24 h, was performed. The implantable materials consisted of cancellous screws or 4 mm diameter cannulated with partial thread and washers.
The surgeries were performed via deltopectoral approach. The coracoacromial ligament and the pectoralis minor muscle were disinserted from the lateral and medial face of the coracoid process, keeping the conjoint tendon intact. Using a curved osteotome, we performed osteotomy of the coracoid process near its base, sparing the coracoclavicular ligaments, obtaining a graft about 2.5-cm long. Bone spicules at the base of the graft and remaining soft tissues were removed. The lower surface of the graft was then decorticated with oscillating saw. Using a 2.5-mm drill, two holes were drilled perpendicular to the longitudinal axis of the graft, 5 to 10 mm apart. The glenoid neck was accessed by a longitudinal incision in the direction of the subscapularis fibers (split), performing the resection of the glenoid labrum and the cruentation of the bone surface. The graft was provisionally fixed to the anterior rim of the glenoid cavity with Steinmann wires. Once the correct positioning of the graft was verified (alignment with the joint surface and below the “equator” of the glenoid) with radioscopy, the neck of the glenoid cavity was drilled and the graft was fixed with two 4-mm diameter partially-threaded cancellous screws. Washers were used in all cases.
Patients used a sling for 21 days and movements for the hand, wrist, and elbow were stimulated from the first postoperative day. The passive movement arc gain was initiated at 14 days, while the active gain at 21 days. Isometric exercises were initiated at 30 days and active resisted at 45 days. Sports that used the upper limbs and manual labor were allowed between four and six months, depending on the arc of movement gain and re-establishment of strength.
The surgeries were performed via deltopectoral approach. The coracoacromial ligament and the pectoralis minor muscle were disinserted from the lateral and medial face of the coracoid process, keeping the conjoint tendon intact. Using a curved osteotome, we performed osteotomy of the coracoid process near its base, sparing the coracoclavicular ligaments, obtaining a graft about 2.5-cm long. Bone spicules at the base of the graft and remaining soft tissues were removed. The lower surface of the graft was then decorticated with oscillating saw. Using a 2.5-mm drill, two holes were drilled perpendicular to the longitudinal axis of the graft, 5 to 10 mm apart. The glenoid neck was accessed by a longitudinal incision in the direction of the subscapularis fibers (split), performing the resection of the glenoid labrum and the cruentation of the bone surface. The graft was provisionally fixed to the anterior rim of the glenoid cavity with Steinmann wires. Once the correct positioning of the graft was verified (alignment with the joint surface and below the “equator” of the glenoid) with radioscopy, the neck of the glenoid cavity was drilled and the graft was fixed with two 4-mm diameter partially-threaded cancellous screws. Washers were used in all cases.
Patients used a sling for 21 days and movements for the hand, wrist, and elbow were stimulated from the first postoperative day. The passive movement arc gain was initiated at 14 days, while the active gain at 21 days. Isometric exercises were initiated at 30 days and active resisted at 45 days. Sports that used the upper limbs and manual labor were allowed between four and six months, depending on the arc of movement gain and re-establishment of strength.
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