Posterior open wedge osteotomy of the scapula neck for the treatment of advanced shoulder osteoarthritis with posterior head migration in young patients

Ortmaier, Reinhold; Moroder, Philipp; Hirzinger, Corinna; Resch, Herbert

doi:10.1016/j.jse.2016.11.005

Cited by 27 publications

(64 citation statements)

References 34 publications

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“…It is possible that the failure of posterior glenoid open wedge osteotomy to correct static posterior subluxation is the cause for the failure to prevent OA or progression of OA. The inability to address the PSH was also reported by Ortmaier et al, 37 who treated 10 shoulders with the posterior open wedge osteotomy for the treatment of a relatively elderly cohort of patients with pre-existing glenohumeral arthropathy associated with PSH. Despite the correction of the retroversion by a mean of 11 , the PSH was unchanged.…”

Section: Discussionmentioning

confidence: 69%

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Long-term results after posterior open glenoid wedge osteotomy for posterior shoulder instability associated with excessive glenoid retroversion

Waltenspül

Häller

Ernstbrunner

et al. 2022

Journal of Shoulder and Elbow Surgery

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Background: Treatment of posterior shoulder instability (PSI) associated with excessive glenoid retroversion is a rare, challenging problem in shoulder surgery. One proposed technique is posterior open wedge glenoid osteotomy to correct excessive glenoid retroversion as described by Scott. However, this operation is rarely performed, and limited long-term outcomes using this approach are available. The goal of this study was to analyze the long-term outcomes of posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion. Methods: Six consecutive patients (7 shoulders) with a mean age of 24 years (range 19-34) were treated with posterior open wedge glenoid osteotomy for PSI associated with a glenoid retroversion greater than 15 and followed up clinically and radiographically at a mean age of 15 years (range 10-19). Results: Recurrent, symptomatic PSI was observed in 6 of 7 shoulders (86%). One necessitated revision with a posterior (iliac crest) bone block procedure and was rated as a failure and excluded from functional analysis. One patient rated his result as excellent, 3 as good, 1 as fair, and 1 as unsatisfactory. Mean relative Constant Score (CS%) was unchanged from preoperation to final follow-up (CS% ¼ 72%) and pain did not significantly decrease (Constant Score ¼ 7-10 points; P ¼ .969). The mean Subjective Shoulder Value (SSV) improved postoperatively, but with 6 patients the improvement did not reach statistical significance (SSV ¼ 42%-67%, P ¼ .053) and the total Western Ontario Shoulder Instability Index averaged 30% at the final follow-up. Mean glenoid retroversion of all 7 shoulders was corrected from 20 (range 16 -26 ) to 3 (range À3 to þ8 ) (P ¼ .018). In the 5 shoulders with preoperative static posterior subluxation of the humeral head, the humeral head was not recentered. All 7 shoulders showed progression of glenoid arthritic changes.Conclusions: Posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion neither reliably restored shoulder stability nor recentered the joint or prevent progression of osteoarthritis. Alternative treatments for PSI associated with excessive glenoid retroversion have to be developed and evaluated.

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Section: Discussionmentioning

confidence: 69%

“…42 This technique corrects glenoid retroversion and should thereby restabilize the glenohumeral joint and recenter the humeral head. Short-term results in patients with excessive glenoid retroversion associated with preoperative PSH provide conflicting information, with good results in some 23 and less satisfactory outcome in other 37 studies.…”

mentioning

confidence: 99%

Long-term results after posterior open glenoid wedge osteotomy for posterior shoulder instability associated with excessive glenoid retroversion

Waltenspül

Häller

Ernstbrunner

et al. 2022

Journal of Shoulder and Elbow Surgery

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“…Does paralyzing the subscapularis (e.g., with Botox) positively influence humeral head recentration? In our study about correction osteotomy of the glenoid in patients with PSSH [ 12 ], we found that retroversion was corrected very well; however, PSSH was not reversed significantly in most of the patients. Taking into account the results of this study, the TFC might be an important future target in treating PSSH.…”

Section: Discussionmentioning

confidence: 99%

“…Eight of these patients have previously been included in a study about correction osteotomy for treating excessive retroversion of the glenoid and PSSH in younger patients [ 12 ]. The remaining patient was treated conservatively (Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

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Muscle volume imbalance may be associated with static posterior humeral head subluxation

Mitterer

Matis

Steiner

et al. 2021

BMC Musculoskelet Disord

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Background The transverse force couple (TFC) of the rotator cuff (subscapularis vs. infraspinatus and teres minor muscle) is an important dynamic stabilizer of the shoulder joint in the anterior-posterior direction. In patients with posterior static subluxation of the humeral head (PSSH), decentration of the humeral head posteriorly occurs, which is associated with premature arthritis. We hypothesize that not only pathologic glenoid retroversion but also chronic muscle volume imbalance in the transverse force couple leads to PSSH. Methods A retrospective analysis of the TFC muscle volumes of 9 patients with symptomatic, atraumatic PSSH, within 8 were treated with glenoid correction osteotomy, was conducted. The imaging data (CT) of 9 patients/10 shoulders of the full scapula and shoulder were analyzed, and the muscle volumes of the subscapularis (SSC), infraspinatus (ISP) and teres minor muscles (TMM) were measured by manually marking the muscle contours on transverse slices and calculating the volume from software. Furthermore, the glenoid retroversion and glenohumeral distance were measured. Results The mean glenoid retroversion was − 16° (− 7° to − 31°). The observed mean glenohumeral distance was 4.0 mm (0 to 6.8 mm). Our study population showed a significant muscle volume imbalance between the subscapularis muscle and the infraspinatus and teres minor muscles (192 vs. 170 ml; p = 0.005). There was no significant correlation between the subscapularis muscle volume and the glenohumeral distance (r = 0.068), (p = 0.872). Conclusion The muscle volume of the SSC in patients with PSSH was significantly higher than the muscle volume of the posterior force couple (ISP and TMM). This novel finding, albeit in a small series of patients, may support the theory that transverse force couple imbalance is associated with PSSH. Level of evidence Level 4 – Case series with no comparison group.

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Management of Failed Posterior and Multidirectional Instability Repair

Brzóska¹,

Laprus²,

Ranosz³

et al. 2018

Management of Failed Shoulder Surgery

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Posterior open wedge osteotomy of the scapula neck for the treatment of advanced shoulder osteoarthritis with posterior head migration in young patients

Cited by 27 publications

References 34 publications

Long-term results after posterior open glenoid wedge osteotomy for posterior shoulder instability associated with excessive glenoid retroversion

Long-term results after posterior open glenoid wedge osteotomy for posterior shoulder instability associated with excessive glenoid retroversion

Muscle volume imbalance may be associated with static posterior humeral head subluxation

Management of Failed Posterior and Multidirectional Instability Repair

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