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Managing Bone Loss in Shoulder Instability—Techniques and Outcomes: a Scoping Review

  • Outcomes Research in Orthopedics (O Ayeni, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The aim of this scoping review is to provide an overview of the literature published over the past 5 years related to the management of bone loss in anterior shoulder instability.

Recent Findings

During recent years, there has been a focus on patients at high risk for failure following soft tissue anterior stabilization (Bankart repair). A growing body of evidence suggests that anterior capsulolabral repair is insufficient in the setting of subcritical glenoid bone loss with an off-track Hill Sachs lesion. In such cases, the addition of a remplissage procedure to a Bankart repair or a bone-block augmentation to the glenoid (Latarjet, for example) is often advocated to decrease the risk of recurrent instability. Recent studies have also evaluated the role of alternative bone-block procedures in comparison to the Latarjet, outcomes with arthroscopic and open techniques as well as various fixation methods and radiological outcomes (bone graft resorption, glenohumeral osteoarthritis).

Summary

Advances in our understanding of subcritical glenoid bone loss and the glenoid track concept have significantly impacted clinical decision making and treatment selection. The development of arthroscopic techniques has allowed for minimally invasive and safe arthroscopic bone-block procedures as an alternative to open procedures. Further research related to free bone-block procedures will inform long-term outcomes between these procedures and the gold standard Latarjet. Additionally, high-quality evidence is lacking to identify the ideal treatment for patients with glenoid subcritical glenoid bone defect. Variability in outcome reporting suggests the need to standardize outcome measures for future instability trials.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Carlos Prada, Omar A. Al-Mohrej & Moin Khan

  2. Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia

    Omar A. Al-Mohrej

  3. Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Ashaka Patel

  4. Research Institute of St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada

    Carlos Prada, Breanne Flood & Moin Khan

  5. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada

    Moin Khan

  6. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

    Timothy Leroux

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Correspondence to Moin Khan.

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Carlos Prada declares that he has no conflict of interest.

Omar A. Al-Mohrej declares that he has no conflict of interest.

Ashaka Patel declares that she has no conflict of interest.

Breanne Flood declares that she has no conflict of interest.

Tim Leroux declares that he has no conflict of interest.

Moin Khan reports grants and personal fees from Arthrex, personal fees from bioventus, and sanofi outside the submitted work.

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Appendices

Appendix 1. Search Strategy

Database

Search terms

# of studies

Medline

1. Osteoporosis/ or Alveolar Bone Loss/ or bone loss*.mp. or Osteoporosis, Postmenopausal/

2. bone los$.mp.

3. Shoulder Joint/ or Joint Instability/ or shoulder instability.mp. or Shoulder Dislocation/

4. treatment.mp. or Therapeutics/

5. treat.mp

6. Pain Management/ or management.mp. or Medication Therapy Management/ or Patient Care Management/or Disease Management/or Self-Management/

7. outcome$.mp. or Patient Outcome Assessment/or Treatment Outcome/or “Outcome and Process Assessment, Health Care”/ or Patient Reported Outcome Measures/

8. 1 or 2

9. limit 3 to humans

10. 4 or 5

11. limit 6 to humans

12. limit 7 to humans

13. 8 and 9 and 10 and 11 and 12

66

CINAHL

1. (MM “Shoulder Instability, Posterior”) OR (MM “Shoulder Instability, Multidirectional”) OR (MM “Shoulder Instability, Anterior”) OR (MM “Joint Instability”)

2. (MM “Osteoporosis”) OR (MM “Alveolar Bone Loss”) OR (MM “Bone Resorption”) OR “bone loss”

3. “therapy”

4. treatment or intervention or therapy

5. management

6. S3 OR S4 OR S5

7. treatment outcomes or efficacy or effectiveness

8. outcomes

9. (MM “Treatment Outcomes”) OR (MM “Clinical Effectiveness”) OR “outcomes or benefits or effects or impact or effectiveness”

10. S7 OR S8 OR S9

11. S1 AND S2 AND S6 AND S10

124

EMBASE

1. bone loss.mp. or osteolysis/

2. secondary osteoporosis/ or osteoporosis.mp. or osteoporosis/ or primary osteoporosis/

3. 1 or 2

4. shoulder instability.mp. or recurrent shoulder dislocation/

5. shoulder dislocation/ or joint instability/ or recurrent shoulder dislocation/ or shoulder joint instability.mp. or shoulder/

6. 4 or 5

7. treatment.mp.

8. management.mp. or management/

9. therapy.mp. or therapy/

10. 7 or 8 or 9

11. outcomes.mp.

12. treatment outcome/

13. 11 or 12

14. 3 and 6 and 10 and 13

15. limit 14 to (human and english language)

396

COCHRANE VIA EMBASE

1. shoulder instability.mp. or recurrent shoulder dislocation/

2. bone loss.mp. or osteolysis/

3. treatment.mp.

4. therapy.mp. or therapy/

5. management.mp. or management/

6. 3 or 4 or 5

7. outcomes.mp.

8. outcome.mp. or treatment outcome/

9. 7 or 8

10. 1 and 2 and 6 and 9

11. limit 10 to (human and cochrane library and english language)

3

PUBMED

1. Search: bone loss$ Filters: Full text, Journal Article, Observational Study, Humans, English

2. Search: shoulder instability Filters: Full text, Journal Article, Observational Study, Humans, English

3. Search: treatment Filters: Full text, Journal Article, Observational Study, Humans, English

4. Search: management Filters: Full text, Journal Article, Observational Study, Humans, English

5. Search: therapy Filters: Full text, Journal Article, Observational Study, Humans, English

6. Search: ((treatment AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter]))) OR (shoulder instability AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter])))) OR (bone loss$ AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter]))) Filters: Full text, Journal Article, Observational Study, Humans, English

7. Search: outcome$ Filters: Full text, Journal Article, Observational Study, Humans, English

8. Search: (((bone loss$ AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter]))) AND (shoulder instability AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter])))) AND (((treatment AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter]))) OR (shoulder instability AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter])))) OR (bone loss$ AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter]))) AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter])))) AND (outcome$ AND ((journalarticle[Filter] OR observationalstudy[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter]))) Filters: Full text, Journal Article, Observational Study, Humans, English

256

Appendix 2. PRISMA flow diagram

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Prada, C., Al-Mohrej, O.A., Patel, A. et al. Managing Bone Loss in Shoulder Instability—Techniques and Outcomes: a Scoping Review. Curr Rev Musculoskelet Med 14, 447–461 (2021). https://doi.org/10.1007/s12178-021-09727-2

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