Two-year follow-up of arthroscopic bone block technique with iliac crest autograft and remplissage in patients with anterior shoulder instability and glenoid bone loss.

Background: To retrospectively evaluate patients undergoing arthroscopic bone-block surgery combined with remplissage for anterior shoulder instability with glenoid bone loss, with a minimum follow-up of 2 years. The study assessed graft positioning, osteointegration, resorption, and functional outcomes. Methods: Patients treated between 2019 and 2023 were retrospectively analyzed. Inclusion criteria included: unidirectional anterior shoulder instability, glenoid bone loss between 10% and 30%, and minimum 2-year follow-up. Exclusion criteria were posterior or multidirectional instability, prior bone-block surgery, or glenoid dysplasia. Preoperative computed tomography scans measured glenoid defects and Hill-Sachs lesions. Postoperative and follow-up computed tomography assessed graft positioning, glenoid index, and resorption. Functional outcomes were measured with pre- and postoperative Constant and Western Ontario Shoulder Instability Index scores. Results: Thirty-two patients (34 shoulders) met inclusion criteria. All underwent arthroscopic iliac crest bone-block fixation and remplissage. Immediate postoperative glenoid width increased from 22.6 ± 1.8 mm to 33.5 ± 1.91 mm (P < .05), stabilizing at 27.9 ± 2.97 mm at 2 years. The glenoid index improved from 0.76 to 1.13 postoperatively, then stabilized at 0.94. Mean graft resorption was 50.51% ± 22.64%; consolidation was achieved in 96.42%. Functional scores significantly improved: Constant score increased from 63.2 ± 9.1 to 87.74 ± 6.3; Western Ontario Shoulder Instability Index score from 1,220.4 ± 380.7 to 394.28 ± 314.5 (81.21%). One patient had recurrence requiring revision. All returned to sports, including the revision case. Conclusion: Arthroscopic bone-block with iliac crest autograft and remplissage is effective for treating anterior shoulder instability with glenoid bone loss. It provides high consolidation rates, significant functional improvement, and low recurrence. Graft resorption does not appear to impair outcomes.