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


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



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



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.



Measurement of glenoid bone loss based on ratios23.



Importance of Bankart fragment length.



Estimation of bone loss based on glenoid rim distances26.



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



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°).



The secant method29 for quantification of bone loss.



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



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



Arthroscopic repair of an osseous Bankart lesion.



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



Drawing showing T-plasty repair.



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



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.



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



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

Documents

journal of bone

joint surgery

estimation of bone loss

quantification of bone

percent bone loss

anterior glenoid bone

glenoid fossa

glenoid rim distances26