Editorial Commentary: All Hands on Deck? The Mooring Technique Balances Biology and Biomechanics in Arthroscopic Anterior Glenoid Rim Fracture Repair.

Abstract

Large anterior glenoid rim fractures challenge the shoulder surgeon to restore stability while minimizing surgical morbidity. As arthroscopic fixation techniques continue to evolve, the pursuit of increasingly robust biomechanical constructs must be balanced against technical complexity and the potential for iatrogenic complications. But how much fixation is adequate to result in a stable shoulder and promote bone healing? With respect to fracture biology, primary compression and AO trauma principles may not be necessary in the glenohumeral joint with appropriate immobilization and postoperative protocols. Alternative fixation strategies that avoid placement of a medial row of anchors, reducing surgical morbidity and potential iatrogenic complications, are useful tools in the surgeon's toolbox. Although no clinical outcome studies exist showing superiority of any technique, a high boney union rate and low recurrent instability rate shows great promise with the mooring technique. However, questions remain regarding long-term cartilage injury with any placement of anchors or sutures along the medial glenoid articular margin. Therefore, applicability of this technique to younger, high-demand athletes, may be limited at this time. This technique represents a thoughtful addition to the shoulder surgeon's armamentarium. Sometimes, the most elegant solution is not the most rigid, it is the one that is sufficiently stable to allow biology to do the rest.