Arthroscopic Bone Block (Eden-Hybinette / Bristow)

⚙️What This Procedure Involves

Performed arthroscopically through several portals. For arthroscopic Bristow: the coracoid tip with its attached conjoint tendon is transferred through a subscapularis split and fixed to the anterior glenoid with a screw — the same principle as the open Latarjet but through keyhole incisions. For Eden-Hybinette: a free bone block (iliac crest autograft or distal tibia allograft) is shaped and fixed to the anterior glenoid with screws through an arthroscopic approach. The labrum is repaired over the bone block. The operation takes one and a half to two and a half hours.

💡Why It May Be Recommended

Arthroscopic bone block is considered when glenoid bone loss exceeds 15–20% (the threshold where soft tissue Bankart repair alone has unacceptable recurrence), in revision instability after failed Bankart repair, and in contact athletes with significant bone loss. It offers the benefits of bone augmentation with potentially less morbidity than open Latarjet.

⚖️Non-Operative Alternatives

Physiotherapy, activity modification, bracing. Arthroscopic Bankart repair (for bone loss under 15%). Open Latarjet procedure (the established gold standard for bone loss).

📋Preparing for Surgery

CT with 3D reconstruction to quantify glenoid bone loss and plan the bone block size and position. MRI arthrogram for labral assessment.

✅Expected Benefits

Restoration of the glenoid arc and shoulder stability. Published recurrence rates are comparable to open Latarjet (approximately 2–5%) in experienced hands. Potentially less post-operative pain and faster recovery than open surgery.

⚠️Common Risks

• Shoulder stiffnessCommon

  Temporary. Physiotherapy essential.

• Loss of external rotationCommon

  Some restriction, similar to open Latarjet.

• Technically demandingExpected

  This is an advanced arthroscopic procedure with a significant learning curve.

🔴Less Common but Serious Risks

• Graft non-union or resorptionUncommon

  The bone block may not heal or may be resorbed.

• Screw complicationsUncommon

  Malposition, migration, or prominence.

• Nerve injuryRare

  Musculocutaneous nerve (Bristow) or axillary nerve.

• Recurrent instabilityUncommon

  Despite bone block, approximately 2–5%.

• Conversion to openUncommon

  May be needed if the arthroscopic procedure cannot be completed safely.

• Donor site painCommon

  Iliac crest pain if autograft is used.

💉Anaesthetic Considerations

General anaesthesia with nerve block. Beach-chair or lateral position.

🏃Recovery and Rehabilitation

Sling for four to six weeks. Gentle exercises from one week. Active movement from six weeks. Strengthening from three months. Contact sport at six months. Full recovery six to nine months.

📅Follow-Up

CT at three months to assess bone block healing and position. Reviews at two weeks, six weeks, three months, and six months.

❓Frequently Asked Questions