New Directions in Grafting Technologies: Up to Date

The ideal graft should have a high rate of integration, a low resorption rate, and a low risk of hardware fixation complications, and it should prevent the progression of osteoarthritis secondary to instability. Glenoid bone grafting techniques are necessary for restoring glenoid width and for preventing instability recurrence, while humeral grafting is used in order to treat symptomatic engaging Hill-Sachs lesions. Coracoid transfer procedures are described along with the more recent autograft techniques by means of the corticocancellous iliac crest bone, the distal clavicle, and the allografts from fresh-frozen femoral or humeral head and from the talus. The complications related to graft resorption are a current limitation of grafting technologies. New perspectives in bone grafting technologies come from the field of the basic science in the form of growth factor-infused bioscaffolds and of engineered functional bio-scaffold ricapitulating endochondral ossification.