Glenoid Reconstruction (Distal Tibial Allograft)

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Glenohumeral Reconstruction to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this procedure is to restore the "platform" of the shoulder socket (glenoid) when there is significant bone loss. When a shoulder dislocates repeatedly, the bone of the socket can wear away or chip off. Without a full socket, the shoulder remains unstable regardless of how many soft-tissue repairs are performed. This page focuses on anatomic reconstruction using a Distal Tibial Allograft (DTA)—a high-density bone graft from a donor that mimics the shape and cartilage of a healthy glenoid.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

Choosing the Right Reconstruction: DTA vs. Latarjet

It is important to distinguish this procedure from the Latarjet Procedure, which uses the patient's own coracoid bone. While both treat bone loss, the decision to perform one or the other should be discussed with your surgeon. A DTA might be recommended for larger bone defects, or posterior ones, where using the coracoid is going to be less feasible. Sometimes, a Latarjet has already been done and failed, in which case a DTA is the salvage procedure of choice. However, while the DTA is dead bone that is being asked to heal, the coracoid is living bone from the patient.

The Procedure

  • The Approach: Performed through an open incision (either anterior or posterior depending on where the bone is missing) to allow for precise placement of the graft.

  • Graft Preparation: Dr. Wall meticulously shapes the distal tibial allograft to match the specific "defect" or hole in your socket.

  • Fixation: The graft is secured to your native bone using two or three high-strength compression screws. Over time, the graft will heal and fuse to the glenoid, making it a permanent part of your shoulder.

  • Labral Repair: Once the bone platform is restored, if possible, the surrounding labrum and capsule are reattached to the graft to ensure the soft tissues are also tensioned correctly.

Post-Op Protocol

The post-op PT protocol for these procedures depends on whether you had an anterior or posterior surgery. Regardless of which though, immobilization in a sling or a brace is necessary for multiple weeks, followed by PT to regain motion and then strength over the span of months.

When to Seek Care

You should schedule a consultation if:

  • You have had a previous "Bankart repair" or "labral repair" that has failed.

  • Your shoulder feels like it is "slipping" or "falling out" with simple daily tasks or in your sleep.

  • You have been told you have significant "glenoid bone loss" or a "bony Bankart" lesion.