recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss...

Recurrent Shoulder Instability: Current Concepts for Evaluation and Management of Glenoid Bone Loss

by CDR Matthew T. Provencher, Sanjeev Bhatia, Neil S. Ghodadra, Robert C. Grumet, Bernard R. Bach, LCDR Christopher B. Dewing, LT Lance LeClere, and

Anthony A. Romeo

J Bone Joint Surg AmVolume 92(Supplement 2):133-151

December 1, 2010

©2010 by The Journal of Bone and Joint Surgery, Inc.

For a West Point axillary view, the beam is directed at the axilla at a 25° angle medially and a 25° angle cephalad, centered inferior and medial to the acromioclavicular joint.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

A: A sagittal image from a magnetic resonance arthrogram demonstrates anterior glenoid bone loss with no identifiable fracture fragment (arrow).

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Glenoid bone loss seen on a three-dimensional computed tomography reconstruction.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

A: A best-fit circle is drawn on the inferior two-thirds of the glenoid fossa to aid with quantification of the percent bone loss.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Measurement of glenoid bone loss based on ratios23.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Importance of Bankart fragment length.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Estimation of bone loss based on glenoid rim distances26.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

The glenoid-bare-spot method25,27 for estimation of the osseous defect size.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

En face drawing of the glenoid fossa, demonstrating the clinical appearance of glenoid bone loss, which usually occurs along a line nearly parallel to the long axis of the glenoid (0°).

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

The secant method29 for quantification of bone loss.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Losses of <15% of the width of the glenoid (<3 to 4 mm from the anterior rim) are probably unimportant in most patients.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Treatment algorithm for surgical management of glenoid bone loss in patients with recurrent shoulder instability.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Arthroscopic repair of an osseous Bankart lesion.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Drawing depicting the anterior view of a shoulder during open shoulder stabilization.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Drawing showing T-plasty repair.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Use of iliac crest bone graft to augment an anterior glenoid osseous deficiency.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

A: The lateral aspect of the distal part of the tibia is an excellent fit for the glenoid, providing a nearly anatomic match of the radius of curvature, glenoid and tibial cartilage thickness, and

dense corticocancellous weight-bearing bone14.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.

Distal tibial allograft technique for reconstruction of osseous defects in the glenoid.

CDR Matthew T. Provencher et al. J Bone Joint Surg Am 2010;92:133-151

©2010 by The Journal of Bone and Joint Surgery, Inc.