Current Treatment Options for Glenohumeral Instability and Bone Loss

Provencher, Matthew T.; Ferrari, Márcio B.; Sánchez, George; Anavian, Jack; Akamefula, Ramesses; Lebus, George F.

doi:10.2106/jbjs.rvw.16.00091

Cited by 23 publications

(26 citation statements)

References 90 publications

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“…Regarding the management of isolated critical humeral bone loss and no previous surgery, a consensus was reached across all subspecialties that a Bankart repair with or without remplissage would be performed. A critical review conducted by Provencher et al 63 established algorithms for treating different types of bone loss. The results of their review, as well as a systematic review and meta-analysis conducted in 2018 by Liu et al, 43 support our findings that combined Bankart repair and remplissage are appropriate for managing recurrent instability with humeral head bone loss of 20%-25% and subcritical glenoid bone loss.…”

Section: Discussionmentioning

confidence: 99%

“… 29 For bipolar lesions, this often necessitates a bony augmentation procedure, and with higher magnitudes of combined bone loss, both the humeral and glenoid sides need to be addressed. 26 , 60 , 63 , 84 …”

Section: Discussionmentioning

confidence: 99%

“… 2 , 8 , 9 , 16 , 17 , 29 , 30 , 51 , 54 , 64 , 78 , 83 However, there is currently no consensus regarding what is considered "critical" or "subcritical" glenoid and/or humeral bone loss, and no level I evidence is available to assist in surgical decision-making. 63 Therefore, the surgical management of critical bone loss remains a topic of debate in the orthopedic surgery community.…”

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confidence: 99%

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Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons

Bois¹,

Mayer²,

Fening³

et al. 2020

JSES International

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Background Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. Methods An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. Results A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. Conclusions Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons

Bois¹,

Mayer²,

Fening³

et al. 2020

JSES International

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“…1 Historically, 20% to 25% has been accepted as the “critical” cutoff value at which glenoid bone loss should be reconstructed during surgery. 2 , 3 Due to the unsatisfactory results reported with isolated capsulolabral repair in athletes with recurrent glenohumeral instability and glenoid bone deficit >20%, most authors recommend glenoid reconstruction with bone grafting in these patients. 2 , 3 …”

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confidence: 99%

High Rate of Return to Sports and Low Recurrences With the Latarjet Procedure in High-Risk Competitive Athletes With Glenohumeral Instability and a Glenoid Bone Loss <20%

Rossi

Gorodischer

Brandariz

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To analyze return to sports, functional outcomes, and complications following the Latarjet procedure in competitive athletes with anterior glenohumeral instability and glenoid bone loss <20%. Methods All the included patients were operated between 2010 and 2016. The inclusion criteria were competitive athletes with anterior glenohumeral instability, a glenoid bone defect <20% who participated in contact sports, forced overhead sports, or had a previous failed Bankart repair and had a minimum 2 years’ follow-up. Return to sports, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System score were used to assess functional outcomes. Complications and bone consolidation were also evaluated. Results A total of 65 athletes were included in the study. The mean follow-up was 53 months (±13), and the mean age was 23.9 years (range, 16-31 years). Overall, 94% were able to return to sports and 84% returned at the same level. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and Athletic Shoulder Outcome Scoring System scores showed statistical improvement after operation ( P < .001). No significant difference in shoulder ROM and functional scores was found between primary and revision cases. The total complication rate was 11% and the revision rate was 1.5% The recurrence rate was 4.6%. The bone block healed in 95% of the cases. Conclusions In high-risk competitive athletes with anterior glenohumeral instability and glenoid bone loss <20%, the Latarjet procedure resulted in excellent functional outcomes, with most of the patients returning to sports and at the same level they had before injury with a low rate of recurrences Level of Evidence Therapeutic case series; Level of evidence, IV

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“…Additionally, it was previously described that MRI may underestimate the degree of glenoid bone loss as compared with CT; therefore, the bone loss measurements in the present scenario could represent a best-case scenario. 39 Last, this study observed statistically significant relative changes in the same shoulder with pre- and postinstability imaging. Therefore, while the absolute value of glenoid bone loss may be more accurately assessed in CT, the relative decrease in glenoid width was consistent with the MRI technique used.…”

Section: Discussionmentioning

confidence: 52%

Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

et al. 2019

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Background: Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. Purpose: To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient’s pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event (P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability (P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.

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Current Treatment Options for Glenohumeral Instability and Bone Loss

Cited by 23 publications

References 90 publications

Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons

Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons

High Rate of Return to Sports and Low Recurrences With the Latarjet Procedure in High-Risk Competitive Athletes With Glenohumeral Instability and a Glenoid Bone Loss <20%

Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

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