Editorial Commentary: Surgical Treatment of Shoulder Instability With Subcritical Glenoid Bone Loss Requires Innovation: Bankart May Risk Significant Recurrence and Latarjet May Risk Significant Complications

Abstract

The patient with a history of shoulder dislocation and subcritical (10%-15%) glenoid bone loss presents a complicated scenario. The "safest" procedure (arthroscopic Bankart repair) may result in a high rate of failure and risk of further surgery. The most successful procedure for avoiding recurrence (Latarjet) comes with potentially high complication rates (of up to 20%), a steep learning curve, risk of permanent nerve injury (up to 15%), and substantial risk of subscapularis deficit. Innovation is most needed in surgery when current treatments lack success or risk significant complications. As surgeons, we are constantly striving to walk the line between using innovative techniques for our patients to better their lives and following the principle "first do no harm." This recent article describes the outcomes of a 2-cm segment of scapular spine harvested through a small incision and stabilized with suture anchors along the anterior glenoid, combined with an arthroscopic labral repair. The technique appears to be safe, and practical, bearing in mind that excellent reported outcomes must be shown to be reproducible. Ideally, we should not have to choose between relatively high failure rates with arthroscopic Bankart repair or the greater reported complication rates with Latarjet. Innovation will pave the way to our greater success.

Reconsidering “Critical” Bone Loss in Shoulder Instability: 17-Year Follow-Up Study following Arthroscopic Bankart Repair

“…The concept of subcritical bone loss poses a treatment dilemma while arthroscopic Bankart repair is a more straightforward and safer operation, and it does carry a potentially higher risk of redislocation while bone augmentation procedures are more complex procedures although they may have a lower likelihood of recurrent dislocation [ 8 ]. In 2008, our group also highlighted the significance of subcritical bone loss in 218 patients with shoulder dislocation showing that “beyond a critical level of 13.4% glenoid bone loss, the number of dislocations experienced rose steeply from six to 10 dislocations” [ 9 ].…”