Long-term results after posterior open glenoid wedge osteotomy for posterior shoulder instability associated with excessive glenoid retroversion

Abstract

Background: Treatment of posterior shoulder instability (PSI) associated with excessive glenoid retroversion is a rare, challenging problem in shoulder surgery. One proposed technique is posterior open wedge glenoid osteotomy to correct excessive glenoid retroversion as described by Scott. However, this operation is rarely performed, and limited long-term outcomes using this approach are available. The goal of this study was to analyze the long-term outcomes of posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion. Methods: Six consecutive patients (7 shoulders) with a mean age of 24 years (range 19-34) were treated with posterior open wedge glenoid osteotomy for PSI associated with a glenoid retroversion greater than 15 and followed up clinically and radiographically at a mean age of 15 years (range 10-19). Results: Recurrent, symptomatic PSI was observed in 6 of 7 shoulders (86%). One necessitated revision with a posterior (iliac crest) bone block procedure and was rated as a failure and excluded from functional analysis. One patient rated his result as excellent, 3 as good, 1 as fair, and 1 as unsatisfactory. Mean relative Constant Score (CS%) was unchanged from preoperation to final follow-up (CS% ¼ 72%) and pain did not significantly decrease (Constant Score ¼ 7-10 points; P ¼ .969). The mean Subjective Shoulder Value (SSV) improved postoperatively, but with 6 patients the improvement did not reach statistical significance (SSV ¼ 42%-67%, P ¼ .053) and the total Western Ontario Shoulder Instability Index averaged 30% at the final follow-up. Mean glenoid retroversion of all 7 shoulders was corrected from 20 (range 16 -26 ) to 3 (range À3 to þ8 ) (P ¼ .018). In the 5 shoulders with preoperative static posterior subluxation of the humeral head, the humeral head was not recentered. All 7 shoulders showed progression of glenoid arthritic changes.Conclusions: Posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion neither reliably restored shoulder stability nor recentered the joint or prevent progression of osteoarthritis. Alternative treatments for PSI associated with excessive glenoid retroversion have to be developed and evaluated.

Arthroscopic Bone Block Procedure for Posterior Shoulder Instability: Updated Surgical Technique

“…Recent studies support the concept that surgical treatment of PSI remains challenging, with poor clinical results at long-term follow-up. 11,12 Since accurate placement of the bone graft remains challenging, we propose an updated version the arthroscopic bone block technique by Lafosse et al 7 using a 2-or 3-portal procedure. The anterolateral portal through the rotator cuff interval increases visibility, which allows the posterior portal to be perfectly aligned with the level of the glenoid.…”

“…Recent studies support the concept that surgical treatment of PSI remains challenging, with poor clinical results at long-term follow-up. 11 , 12 Since accurate placement of the bone graft remains challenging, we propose an updated version the arthroscopic bone block technique by Lafosse et al. 7 using a 2- or 3-portal procedure.…”

“… 5 , 6 , 9 , 19 Posterior open-wedge glenoid osteotomy, used in patients with excessive glenoid retroversion, is associated with high reported rates of recurrent PSI (86%) and osteoarthritis (100%) at long-term follow-up. 12 Bone block procedures using distal tibial grafts have shown good clinical outcomes, but literature on this procedure is scares. 19 The more commonly used iliac crest bone graft procedure is associated with high recurrence and revision rates of up to 73% and 40% when performed open and 21% and 67% when performed arthroscopically.…”

The Surgical Treatment of Osteoarthritis

“…Osteotomies around the shoulder may be used in selected cases as a way of preventing or delaying the degeneration associated with morphologically and/or biomechanically abnormal articulation [ 32 , 33 , 34 , 35 ].…”

Arthroscopic Posterior Capsulolabral Reconstruction With Gracilis Allograft

“…Glenoid retroversion is a known factor in refractory posterior instability, but glenoid osteotomy is technically difficult, fraught with complications such as intra-articular fracture, and has mixed results in terms of outcomes. 14 Scapular kinematics may be impaired either as a cause of posterior instability or an adaptation to it. Thin or capacious posterior capsule, glenoid hypoplasia, or chondrolabral retroversion, diminutive labrum, MDI, hyperlaxity, or unrecognized tears may all contribute.…”