Applying the Glenoid Track Concept in the Management of Patients with Anterior Shoulder Instability

Abstract

Purpose of Review The purpose of this paper is to evaluate the recent evolution in the treatment of anterior shoulder instability and the dynamic interaction between the glenoid and HillSachs lesion. Recent Findings Through the glenoid track concept, glenoidand humeral-sided bone loss are evolving away from being approached as separate entities. Recent cadaveric studies have validated the glenoid track concept. Moreover, a recent clinical study has demonstrated a much higher rate of failure after arthroscopic Bankart repair for shoulders that were off track. Summary The glenoid track concept is a useful tool in evaluating patients with anterior shoulder instability. Shoulders that are off track may require more than a simple arthroscopic Bankart, and the addition of a remplissage or bony transfer may be considered.

A avaliação do método tomográfico glenoid track na ressonância magnética/artro RM

“…3,13 However, to reduce costs and radiation exposure, the use of MRI/arthro-MRI have been studied for this purpose. 1,4,14 The engagement concept was proposed initially by Burkhart and De Beer 7 to explain factors related to instability recurrence after an arthroscopic Bankart surgery. Patients bearing these injuries, with the shoulder in abduction and lateral rotation, would be predisposed to the "engagement" of HSL on the anterior edge of the glenoid, leading to joint instability.…”

“…Proper assessment of patients with traumatic anterior shoulder instability is still a challenge for orthopedists. 1 A precise, detailed study of soft tissue and bone lesions in glenohumeral instability requires three-dimensional-reconstructed computed tomography (3D-CT), magnetic resonance imaging (MRI) or arthro-MRI scans, which can increase propaedeutic costs, delay and bureaucratize treatment. 2 The dynamic interaction between bone losses at the proximal humerus and the glenoid in traumatic anterior shoulder dislocation, the so-called lesion bipolarity, was described in 3D-CT using the glenoid track (GT) concept.…”

How to handle minor and major bone loss in the shoulder? Current concepts

“…Defined by simultaneous bone loss in both the glenoid and the humeral head, bipolar bone loss is strongly correlated o failure of soft tissue repair and must be addressed in the surgical management of chronic shoulder instability 6–10. While Hill-Sachs lesion (HSL) and bony Bankart lesions are individually well characterised within the literature, the incidence of bipolar bone loss is not well known, although it is suspected to occur in up to 84% of all patients with recurrent shoulder instability 8 9 11–13.…”

“…While Hill-Sachs lesion (HSL) and bony Bankart lesions are individually well characterised within the literature, the incidence of bipolar bone loss is not well known, although it is suspected to occur in up to 84% of all patients with recurrent shoulder instability 8 9 11–13. By quantifying the degree and dimensions of bone loss on CT or MRI, the glenoid track concept developed by Di Giacomo and Itoi can be used to predict for risk of dislocation by identifying lesions as ‘on-track’ and thus, low risk of dislocation, or ‘off-track’, and thus high risk of dislocation 6 7 11 14. Also, failing to recognise these lesions can be a source of error and lead to treatment failure and subsequent revision surgery.…”

Avaliação da trilha da glenoide no ombro

“…Inicialmente essas lesões eram avaliadas individualmente mas, durante o século XXI, essa visão mudou e começou-se a entender essas lesões como bipolares e integradas [31][32][33][34][35][36][37][38][39]…”