1. Step-Cut Bone-Graft Technique for Osteoarthritis with Severe Glenoid Bone Loss by Vani Sabesan, Vinay Sharma, Mark Callanan, Jason Ho, and Joseph Iannotti JBJS Essent Surg Tech Volume 4(3):e14 July 22, 2014 ©2014 by The Journal of Bone and Joint Surgery, Inc.

2. The glenoid plane is defined by three points (Fig. 1-A), and glenoid bone loss is measured as the difference from the normal anatomy based on the vault model and the pathological anatomy based on midlevel axial cuts (Fig. 1-B). Vani Sabesan et al. JBJS Essent Surg Tech 2014;4:e14 ©2014 by The Journal of Bone and Joint Surgery, Inc.

3. The posterior side of the glenoid is burred as a step cut to a depth similar to the defect. Vani Sabesan et al. JBJS Essent Surg Tech 2014;4:e14 ©2014 by The Journal of Bone and Joint Surgery, Inc.

4. The superior-inferior and anterior-posterior dimensions of the prepared posterior defect are measured, and a template is cut to match the shape and size of the posterior defect. Vani Sabesan et al. JBJS Essent Surg Tech 2014;4:e14 ©2014 by The Journal of Bone and Joint Surgery, Inc.

5. Access to the joint is achieved by placing a lamina spreader into the joint in contact with the anterior aspect of the glenoid and the humeral osteotomy surface. Vani Sabesan et al. JBJS Essent Surg Tech 2014;4:e14 ©2014 by The Journal of Bone and Joint Surgery, Inc.

6. The bone graft is stabilized with 2.0-mm Kirschner wires (Fig. 5-A) as well as 4.0-mm cannulated cancellous screws (Fig. 5-B). Vani Sabesan et al. JBJS Essent Surg Tech 2014;4:e14 ©2014 by The Journal of Bone and Joint Surgery, Inc.

7. The graft and native glenoid are reamed to yield a uniform surface (Fig. 6-A). Vani Sabesan et al. JBJS Essent Surg Tech 2014;4:e14 ©2014 by The Journal of Bone and Joint Surgery, Inc.