Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

Hines, Adam C.; Cook, Jay B.; Shaha, James S.; Krul, Kevin P.; Shaha, Steven H.; Johnson, John D.; Bottoni, Craig R.; Rowles, Douglas J.; Tokish, John M.

doi:10.1177/0363546517750628

Cited by 37 publications

(58 citation statements)

References 22 publications

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“…Intra- and interobserver reliabilities were calculated (intraobserver was based on 2 calculations performed 1 month apart). On the basis of previous anterior instability studies that demonstrated a clinical significance of 13.5% bone loss, 14,19,33 we used 13.5% pGBL as our threshold for defining minimal versus moderate bone loss.…”

Section: Methodsmentioning

confidence: 99%

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

et al. 2020

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Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

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Section: Methodsmentioning

confidence: 99%

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

et al. 2020

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“…27 Despite some authors' proposal that soft-tissue repair with bone loss greater than 20% remain unstable, 28 the percentage of critical posterior glenoid bone loss is yet to be defined. 29,30 The use of arthroscopic bone block techniques is being adopted more widely nowadays because of their potential benefits, the minimally invasive nature of arthroscopy procedures. and the association between graft osteolysis and glenohumeral osteoarthritis and metal implants.…”

Section: Discussionmentioning

confidence: 99%

“… 27 Despite some authors’ proposal that soft-tissue repair with bone loss greater than 20% remain unstable, 28 the percentage of critical posterior glenoid bone loss is yet to be defined. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

Arthroscopic “Bone Block Cerclage” Technique for Posterior Shoulder Instability

Hachem

D’O

et al. 2020

Arthroscopy Techniques

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Many open and arthroscopic techniques have been described to treat posterior glenohumeral instability. Multifactorial features of posterior shoulder instability pathoanatomy and varied patient characteristics have challenged the understanding of this condition and have led to dissimilar results, without a strong consensus for the most adequate technique to treat it. We describe an arthroscopic anatomical metal-free posterior glenoid reconstruction technique, using a tricortical iliac crest allograft with 2 ultra-high strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL) with concomitant posterior capsulolabral complex reconstruction procedure.

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“…The authors should be commended for continuing to expand upon their body of work on glenoid bone loss. Although most focus has been placed on anterior bone loss, the prevalence of posterior glenoid bone associated with instability was recently illuminated in a retrospective study by Hines et al 2 They discovered posterior bone loss to be present in 22 of 32 total patients with clinically significant instability; 7 of 32 (22%) had bone loss exceeding 13.5%, and 2 of 32 (6%) had bone loss exceeding 20%. 2 This study demonstrates that these lesions may be more common than we previously thought.…”

Section: See Related Article On Page 2319mentioning

confidence: 99%

Editorial Commentary: Bone Loss in Shoulder Instability Occurs in 3 Dimensions

Nacca

Owens

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The continued debate regarding the appropriate threshold to consider performing bony stabilization procedures in the treatment of shoulder instability has contributed to a recent boom of new research in this area. The contribution of both glenoid bone loss and version in predicting potential clinical failure after soft tissue stabilization is one of those topics. The authors of the featured study demonstrate the relationship between measured glenoid version and bone loss, which can assist us in our clinical decision making. To date, most measures of glenoid version have been reported based on analysis of 2 dimensions. However, with 2-dimensional analysis, bone loss may result in potentially errant measurement of version and require subsequent correction. Moreover, 3-dimensional analysis could result in a more nuanced understanding of the complexities of glenoid pathologic study in patients with shoulder instability.

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Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

Cited by 37 publications

References 22 publications

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

Arthroscopic “Bone Block Cerclage” Technique for Posterior Shoulder Instability

Editorial Commentary: Bone Loss in Shoulder Instability Occurs in 3 Dimensions

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