Indications and outcomes of glenoid osteotomy for posterior shoulder instability: a systematic review

Abstract

Background There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability. Methods A search of Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials was conducted from the date of origin to 28th November 2019. Nine out of 3,408 retrieved studies met the inclusion criteria and quality was assessed using the Methodological Index for Non-randomized Studies tool. Results In 356 shoulders, the main indication for osteotomy was excessive glenoid retroversion (greater than or equal to approximately −10°). The mean preoperative glenoid version was −15° (range, −35° to −5°). Post-operatively, the mean glenoid version was −6° (range, −28° to 13°) and an average correction of 10° (range, −1° to 30°) was observed. Range of motion increased significantly in most studies and all standardized outcome scores (Rowe, Constant–Murley, Oxford instability, Japan Shoulder Society Shoulder Instability Scoring and mean shoulder value) improved significantly with high rates of patient satisfaction (85%). A high complication rate (34%, n = 120) was reported post-surgery, with frequent cases of persistent instability (20%, n = 68) and fractures (e.g., glenoid neck and acromion) (4%, n = 12). However, the revision rate was low (0.6%, n = 2). Conclusion Glenoid osteotomy is an appropriate treatment for posterior shoulder instability secondary to excessive glenoid retroversion. However, the high rate of persistent instability should be considered when making treatment decisions. Level of Evidence: Systematic review; Level 4

Arthroscopic Posterior Glenoid Osteotomy

“…In a recent systematic review, Sardar et al. 23 found that glenoid version was corrected by an average of 10° with a subsequent improvement in normal range of motion. Moreover, the overall function showed improvement as assessed by various scoring systems, including Constant-Murley, Rowe, Oxford instability, Japan Shoulder Society Shoulder Instability Scoring, and mean shoulder value.…”

“…They recommend that qualified shoulder surgeons should perform the glenoid osteotomy. 23 This recommendation highlights the complexity and potential risks involved in the procedure.…”

Management of Bone Loss in Posterior Glenohumeral Shoulder Instability

“…Although glenoid bone loss may be acquired as a result of posterior instability events and lead to recurrent instability, inherited glenoid bony abnormalities in the way of pathologic retroversion or glenoid dysplasia are another potential cause of PSI. Current indications for a posterior glenoid opening wedge osteotomy include recurrent PSI in the setting of excessive glenoid retroversion, defined as retroversion ≥10 to 15° 38 . As introduced by Scott in 1967, this procedure involves performing an osteotomy of the posterior glenoid neck and placing graft to wedge the glenoid into a more anatomic version 39 .…”

Posterior Glenoid Bone Loss and Instability: An Evidence-based Approach to Diagnosis and Management

“…However, outcomes are mixed, and this procedure is rarely done in current practice. Sardar et al 33 conducted a systematic review including 356 shoulders that underwent glenoid osteotomy. Preoperatively, mean glenoid retroversion was 15° and mean correction was 10°.…”