Remodelling and the fate of bone grafts in shoulder instability surgery.

Abstract

Anterior glenoid bone loss is a critical factor in the surgical management of recurrent shoulder instability. In cases where bone loss exceeds the threshold for soft-tissue repair, bony augmentation is necessary to restore joint stability and prevent recurrence. However, there remains considerable debate regarding the optimal surgical technique and graft selection to maximise clinical outcomes and ensure long-term graft survival. The Latarjet procedure is widely performed and associated with high success rates. Nevertheless, it is not without limitations, particularly the potential for postoperative complications and inconsistent graft resorption rates. Distal tibial allograft (DTA) has emerged as a biomechanically favourable alternative. Its osteochondral surface offers a strong anatomical match for the glenoid and has shown promising clinical results. Despite its growing adoption, critical questions remain regarding long-term graft incorporation, structural remodelling, and recurrence rates. This review summarises the current evidence surrounding anterior glenoid bone augmentation techniques for shoulder instability, with a focus on graft selection, graft behaviour, and radiographic assessment. Special attention is given to the development and optimisation of DTA based on clinical outcomes and experience. Resorption patterns of the most common techniques and grafts employed, both auto- and allografts are discussed, and remodelling is defined. Understanding these remodelling patterns has practical implications for graft selection, fixation strategy, and postoperative management to optimise healing and long-term stability. Level V.