The posterior bone block procedure in posterior shoulder instability

Abstract

We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years' follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations.

Comparison of Glenohumeral Contact Pressures and Contact Areas After Posterior Glenoid Reconstruction With an Iliac Crest Bone Graft or Distal Tibial Osteochondral Allograft

“…Posterior bone block augmentation with an ICBG is the most often reported bone grafting technique, 1,8,12,14,17,[28][29][30] but long-term outcomes have been inconsistent, often with discouraging results including the development of glenohumeral arthritis.…”

Management of recurrent shoulder instability in patients with epilepsy

“…Poor results have also been noted after bone block procedures for posterior instability, in which outcomes deteriorate in the long term and are characterized by a high rate of recurrence (36%) and patient dissatisfaction (45%). 44,64 This has been attributed to the more extensive surgical approach required to visualize the posterior structures, the inability to identify all the associated pathologic lesions, and the limited capacity of a posteriorly situated bone block to restore stability. 52,69 In the presence of bone loss, though, posterior bone block procedures effectively treat instability and improve functional outcome.…”

Glenohumeral arthritis in the young patient

“…63,75,98 Malalignment or malpositioning of posterior or anterior glenoid bone grafts can also lead to early arthrosis. 1,43,58,59,66,87 Altered glenohumeral joint forces may result from overtightening of the anterior capsule intended to correct instability in the young patient. This results in loss of external rotation with increased compressive load on the posterior articular cartilage of the glenohumeral joint and potentially rapid articular wear (Fig.…”