Management of Glenoid Defects in Anterior Shoulder Instability: A Review of Current Concepts

Abstract

Background:Bone defects of the glenoid are often found in patients with traumatic anterior glenohumeral instability. There is no consensus regarding which glenoid defects need to be treated surgically. The aim of this review is to describe the management of glenoid defects in anterior shoulder instability in patients with traumatic anterior glenohumeral instability.Methods:We conducted a review of the literature through a Pubmed search.Results:The management of glenoid defects in anterior shoulder instability consists of conservative or operative treatment. There is a wide variety in the treatment options. Also, the diagnostics of the presence and size of a glenoid bone defect is still debated on in literature.Conclusion:Based on the current available literature, we advise to begin management of traumatic anterior shoulder instability combined with glenoid defects with conservative treatment. Operative treatment can be used when the bone fragment consists of a large glenoid surface and the patient is active, or in the case of a chronic defect or recurrent instability.

Biomechanical Comparison of the Long Head of the Biceps Tendon Versus Conjoint Tendon Transfer in a Bone Loss Shoulder Instability Model

“…10,15,19 Shaha and colleagues 24 reported that 13.5% glenoid bone loss was associated with poor outcomes in patients who underwent isolated arthroscopic labral repair. They measured bone loss using magnetic resonance imaging with the perfect circle technique described by Harmsen and Huijsmans, 13 and patients were divided into quartiles based on the percentage of bone loss. They arbitrarily set the subcritical threshold cutoff at 13.5%.…”

“…6,7 Although Bankart repair is an effective method for addressing recurrent anterior shoulder instability, recent studies have demonstrated that failure to address glenoid bone loss is a common cause of recurrent instability after isolated Bankart repair. 4,10,13,17,25,26 In contrast to subcritical bone loss, multiple studies have defined critical bone loss of the anterior glenoid associated with recurrent anterior shoulder instability after Bankart repair, with percentages reported ranging from 15% to 30%. 9,11 Several open and arthroscopic operative techniques are utilized to reconstruct the glenoid with a variety of autograft and allograft sources.…”

“…9,11 Several open and arthroscopic operative techniques are utilized to reconstruct the glenoid with a variety of autograft and allograft sources. 1 –3,12 –14,16,20 –23,34 The Bristow-Latarjet procedure is being used with increasing frequency for addressing recurrent shoulder instability in the setting of glenoid bone loss. This surgical technique restores the congruity of the deficient glenoid by augmenting the anterior glenoid with the coracoid process.…”

Arthroscopic Anatomic Glenoid Reconstruction Using Distal Tibial Allograft for Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes

“…3,10 Various glenoid reconstruction procedures that were designed to address the bone loss have been described, and they include the Latarjet procedure, arthroscopic iliac crest bone graft augmentation, and free bone block transfers. 8,18 The Latarjet procedure has shown good to excellent clinical outcomes in terms of recurrence of stability and is the current gold standard for the management of glenoid bone loss; however, a concern with this procedure is an underappreciated complication rate, reported between 15% and 30%, which includes serious neurovascular injuries, difficulties in revision, chances of long-term progression to glenohumeral arthritis (attributed to the nonanatomic reconstruction technique), and graft resorption. 7,16,18 To avoid serious neurovascular injuries, an arthroscopic anatomic glenoid reconstruction (AAGR) technique using a frozen distal tibial allograft (DTA) with patients in the lateral decubitus position was developed.…”

Shoulder Instability. Current Concepts and Controversies

“…The second part is focused in anterior instability with four reviews of the natural history [ 9 ], management alternatives of bone defects [ 10 , 11 ] and soft tissues [ 12 ] in instability and a fifth over the failed shoulder instability patient [ 13 ]. Three “controversies” papers focus in specially disputed topics: management of the first shoulder dislocation [ 14 ], open or arthroscopic procedures [ 15 ] and associated procedures during Bankart repair [ 16 ].…”