Posterior shoulder instability: current concepts review

Abstract

For surgical treatment to be successful, the instability must be attributable to mechanical factors that can be modified by surgery. Because of better knowledge of the pathology, a more specific surgery can be performed. This lesion-specific surgery has improved clinical results compared to non-anatomic stability procedures, particularly when that surgery has been performed arthroscopically.

Arthroscopic Distal Tibial Allograft Augmentation for Posterior Shoulder Instability With Glenoid Bone Loss

“…Patients with recurrent instability typically recall a single event that initiated the process, followed by repeated episodes of apprehension or instability with positional progression from extremes of motion to midrange motion. 4,5,8 Standard radiographs (anteroposterior, axillary lateral) may appear normal, but careful examination can detect subtle abnormalities that can predispose to posterior instability, such as glenoid hypoplasia, posterior rim deficiency, and glenoid retroversion. Magnetic resonance imaging is useful to detect capsuloligamentous pathology and articular cartilage loss.…”

“…Three-dimensional reconstructions with humeral head subtraction can improve the accuracy of quantifying the extent of glenoid bone loss. 1,[4][5][6] It is well recognized that anterior glenoid bone loss is a significant contributor to recurrent anterior instability if the defect amounts to greater than 25% of the articular surface. The current gold-standard treatment for glenoid bone loss in the setting of recurrent instability is a coracoid transfer with the Bristow-Latarjet procedure.…”

“…As such, bone augmentation procedures for posterior glenoid bone loss have been described in a similar fashion to anterior glenoid bone loss to prevent recurrent instability (Table 1). [4][5][6] In this technique article with video, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation.…”

Arthroscopic Posterior Shoulder Stabilization With an Iliac Bone Graft and Capsular Repair: A Novel Technique

“…1,2 The posterior Bankart procedure with reinsertion of the dorsal labrum and capsular shift has been effective in post-traumatic cases without hyperlaxity, as well as in cases of recurrent posterior subluxation. 10 Fronek et al 6 reported a 91% success rate after posterior shoulder stabilization in a series of 11 patients treated with open capsulorrhaphy.…”

“…1,2 Commonly, soft-tissue reconstructions are performed in the case of capsulolabral lesions and normal bony anatomy, but especially in the presence of traumatic posterior bony Bankart lesions, glenoid erosion, or posterior glenoid dysplasia, open bone grafting techniques have been reported [3][4][5][6][7] ( Fig 1, Table 1). Even in the absence of osseous deficiency, many authors have performed posterior bone block procedures to reduce the high rate of recurrent instability reported after soft-tissue repairs.…”