Glenoid Rim Lesions Associated with Recurrent Anterior Dislocation of the Shoulder

Abstract

Twenty-five shoulders with recurrent instability and associated anterior glenoid rim lesions were reviewed to 1) develop a classification system of the lesions, 2) evaluate radiographic techniques in detecting the lesions, and 3) analyze the outcome of surgery. Lesions were classified into three types: Type I, a displaced avulsion fracture with attached capsule; Type II, a medially displaced fragment malunited to the glenoid rim; and Type III, erosion of the glenoid rim with less than 25% (Type IIIA) or greater than 25% (Type IIIB) deficiency. Lesions were detected by plain radiographs (19 shoulders) or supplemental CT-arthrograms (12 shoulders) or both. In 16 Type I fractures, both the bony fragment and capsule were reattached to the glenoid rim. In five Type II and three Type IIIA lesions, only the capsule was repaired to the remaining glenoid rim. In the one Type IIIB lesion, a coracoid transfer was performed. At an average followup of 30 months, 22 shoulders (88%) had satisfactory results without recurrent instability, whereas three shoulders (12%) had postoperative redislocations. The majority of recurrent anterior dislocations with associated glenoid rim lesions can be treated by suturing the fracture fragment or capsule or both to the glenoid rim and addressing associated capsular laxity.

Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

“…Traumatic anterior glenohumeral dislocations or subluxations can lead to recurrent instability, especially in young contact athletes and epileptic patients with humeral and/or glenoid bone loss [3] . Failure to identify and address the bone loss when planning treatment can result in unsuccessful soft tissue stabilization procedures being performed with recurrent dislocations [2,4] . This has been previously demonstrated by Burkhart and De Beer [2] where 89% of contact athletes who failed soft tissue stabilization procedures were found to have significant bone loss.…”

A study of management of tibial diaphyseal fractures with intramedullary interlocking nail: A study of 50 cases

“…It is fibrous rim around the glenoid fossa, which is triangular in cross section. It deepens glenoid fossa by 50% and increases humeral contact to 75 % [2,11,12] . Bankart lesion, detachment of the antero-inferior labrum causes recurrent anterior instability [13] .…”

Clinical Results of the Arthroscopic "Multiple Pulled Suture" Technique for Large or Comminuted Bony Bankart Lesion

“…In patients with bone losses >25% of the diameter of the inferior glenoid without a remnant fragment, many surgeons recommend a glenoid reconstruction procedure, such as an autobone graft, an allobone graft, the Bristow procedure, or the Latarjet procedure. 23,25) We recommend fixing the fragment and a labroligamentous complex repair in cases of glenoid bone loss >25% of the diameter of the inferior glenoid if a bony fragment remains. The total surface of the inferior glenoid cannot be restored by fixing the remnant fragment, but the width of the inferior glenoid can be partially restored.…”