Editorial Commentary: Open Posterior Shoulder Stabilization—When Is It Needed? Glenoid Bone Loss Patterns Are Not Created Equal

Abstract

Posterior shoulder instability remains a poorly understood pathologic entity. Our current treatment algorithm of simple posterior shoulder instability is fairly straightforward, with most patients receiving arthroscopic capsulorrhaphy with labral repair. However, in those with a failed arthroscopic intervention and/or with bony pathology, the optimal treatment is much less clear. As we move forward to evaluate how to optimally treat these patients, it will be critical to better understand the bony pathologies, including those with true posterior glenoid bone loss versus glenoid retroversion. Using novel methods to identify, measure, and quantify the different glenoid morphologies will be the foundation for improving the treatment of these complex and poorly understood pathologies.

Trends in the surgical treatment of posterior shoulder instability in the United States from 2016 to 2020

“…Some authors suggest open capsulorrhaphy should be used following the failure of an arthroscopic procedure or when patients have no obvious labral detachment or when patients have associated inferior instability suggesting excessive capsular laxity. 15,16 In a more recent meta-analysis of open and arthroscopic stabilization for PSI, DeLong et al demonstrated a trend toward more favorable results following arthroscopic techniques for recurrence rate (8% vs. 19%), subjective stability (91% vs. 80%), patient satisfaction (94% vs. 86%), return to sport at any level (92% vs. 66%), and return to the previous level of play (67% vs. 37%). 6 However, to optimize outcomes in patients presenting with PSI, it is imperative that additional prospective studies be performed to better understand which patient and injury characteristics may benefit more from open rather than arthroscopic stabilization, such as age, activity level, sports played, and various soft tissue and boney abnormalities.…”

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

“…17,18 The mean proportion of males was 80% based on five studies. 15,16,[19][20][21] Mean follow-up was between 1 and 10.8 years based on six studies (9 years [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] 6,10,15,16,20,21 All nine studies used the posterior open wedge technique. Seven studies used an autograft derived from the iliac crest, 10,15,16,[18][19][20][21] two from the acromion, 19,21 two from the scapular spine, 6,18 and one study did not report the autograft source.…”

“… 1 Posterior instability accounts for approximately 2–10% of shoulder instability cases and can manifest itself on a spectrum, ranging from mild subluxation to frank dislocation. 2 – 6 Causation is often multifactorial including, glenoid retroversion, trauma, posterior labral tears, hyperlaxity and poor neuromuscular control. 7 – 9 Due to the wide spectrum of clinical manifestations and aetiologies, it can be challenging to determine appropriate indications for treatment.…”

“…2,8,10,11 There is limited evidence on the management of posterior shoulder instability. 3 To our knowledge, this is the first systematic review analyzing the indications and outcomes of glenoid osteotomy used to treat this condition. Through our analysis, we aim to evaluate its clinical effectiveness while providing some direction on which patients would most benefit from the surgical procedure.…”

Digital dynamic radiography—a novel diagnostic technique for posterior shoulder instability: a case report

“… 16 Furthermore, the challenges in evaluation of posterior instability likely underlies the challenges in treating this challenging pathology, with mixed results in open and arthroscopic treatments. 4 , 6 , 7 , 8 , 14 , 18 , 19 …”