Innovative Approaches in the Management of Shoulder Instability: Current Concept Review

Abstract

Purpose of Review This article summarises the latest innovations and concepts in the management of shoulder instability associated with glenoid bone loss. Recent Findings The management of shoulder instability has undergone significant evolution in the last century with rapid strides being made in the last few decades due to the transition from open to arthroscopic techniques allowing management of pathological entities which were previously untreatable. However, there is no consensus on treatment methods, especially in the presence of glenoid bone loss. The complication profile associated with non-anatomic glenoid bony reconstruction procedures has triggered research for alternate techniques using free bone grafts. Open Latarjet procedure continues to be the gold standard in the face of glenoid bone loss; however, arthroscopic anatomic glenoid reconstruction with bone block grafts is gaining in popularity and is associated with excellent short-term clinico-radiologic outcomes. Summary Arthroscopic anatomic glenoid reconstruction using bone grafts has been proposed as an alternative to the complex allarthroscopic Latarjet procedure with excellent short-term results, minimal complications and a relatively easier learning curve. Capsular reconstruction has emerged as option for the management of instability with poor quality or absent capsular tissue. Future long-term outcome studies and randomised comparative trials will determine if these innovations stand the test of time.

Arthroscopic Bone Block Cerclage: A Fixation Method for Glenoid Bone Loss Reconstruction Without Metal Implants

“…Many surgical techniques have been described to treat these patients, but most of them involve metal devices. Two techniques used nonmetal hardware with good results, 21 but only a few arthroscopic techniques have been described 9 , 16 , 22 . Anatomical arthroscopic glenoid reconstruction techniques offer advantages such as a low recurrence rate, good functional results, maintenance of the integrity and function of coracobrachialis, short head of the biceps, and pectoralis minor, and preservation of the normal function of the subscapularis tendon 23 , 24 .…”

“…Failure is defined by the presence of defects greater than 15% to 20%, 3 but ‘’subcritical’’ bone loss is also associated with a subjective feeling of instability and poorer results 4 . Although anatomical and nonanatomical bone graft reconstruction have been used for the treatment of these cases, most of these techniques use metal implants for fixation, independent of the graft used 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17. Bone resorption and residual pain are considered to be closely related to the absence of a sufficiently stable graft fixation and the presence of metal implants 18, 19, 20…”

Current Concepts In Shoulder Arthroscopy

“…Shoulder pain has been defined as the second-most common musculoskeletal disorder after low back pain [1][2][3][4][5][6][7][8][9][10][11][12] . Rotator cuff tears are among the most common causes of pain and functional disability in the shoulder, which generally affect the supraspinatus tendon.…”

“…The acromioclavicular joint (ACJ) is one of the more common sites of shoulder girdle injury, accounting for 4-12% of all such injuries, with an incidence of 3-4 cases per 100 000 persons per year in the general population [6,7] . In daily clinical practice, both arthroscopically assisted acromioclavicular joint stabilization for dislocation injury with so-called "pulley systems" and hook plate fixation are regarded as standard techniques.…”

Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

“…The classic Latarjet surgery has proved to be effective for the management of recurrent anterior glenohumeral instability with glenoid bone deficiency in the general population and in competitive athletes. 5,14,[17][18][19][20] However, it is not exempt from complications. A recent systematic literature review evaluated 13 studies with a minimum follow-up of 10 years in patients who underwent the classic Latarjet surgery.…”