Arthroscopic Glenoid Bone Grafting with Iliac Crest Autograft

Who is a candidate?
Some patients with shoulder instability develop significant bone loss of the socket (glenoid) after repeated dislocations. When too much bone is missing, a standard labral repair alone may not be enough to keep the shoulder stable. In these cases, glenoid bone grafting may be recommended. This procedure is often offered to younger, active patients or athletes who continue to experience dislocations despite prior repairs, especially when imaging shows substantial socket bone loss.

What does the surgery involve?
This is an advanced, minimally invasive arthroscopic technique. Through small incisions and the use of a camera, the surgeon prepares the front of the shoulder socket and then carefully places a piece of the patient’s own bone (taken from the iliac crest—the top rim of the pelvis bone). The bone graft is secured to the glenoid with specialized fixation devices, restoring the socket’s depth and stability.

Because it is performed arthroscopically, this procedure allows the surgeon to preserve surrounding tissues, including the subscapularis muscle at the front of the shoulder, which is often split or detached in more traditional open surgeries. Preserving the subscapularis can mean less pain, faster recovery, and better long-term shoulder function.

How is this different from a Latarjet procedure?
Both iliac crest bone grafting and the Latarjet are designed to restore lost bone and improve shoulder stability. The Latarjet procedure uses a piece of bone (the coracoid) from the shoulder blade, often involving cutting or splitting the subscapularis muscle. While effective, this can change shoulder anatomy and mechanics.

In contrast, arthroscopic iliac crest bone grafting restores the socket with the patient’s own bone while preserving the normal shoulder anatomy. It avoids altering the coracoid or subscapularis, which can be especially important for patients wanting to maintain as much natural shoulder function as possible.

What are the potential downsides or risks?
As with any bone graft surgery, risks include graft non-healing, hardware irritation, or persistent instability. There is also some discomfort at the pelvis bone donor site, although this usually improves with time. The procedure is technically demanding and performed at specialized centers.

What is recovery like?
Recovery is similar to other stabilization surgeries. The arm is supported in a sling for the first several weeks. Physical therapy starts with gentle motion exercises to protect the graft while it heals, followed by progressive strengthening. Full return to sports and heavy activities usually takes 3-4 months, allowing the graft time to fully incorporate into the shoulder socket.