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Management of Complex Anterior Shoulder Instability: a Case-Based Approach

Abstract

Purpose of the Review

The goal of this review is to provide a guide on surgical decision-making options for complex anterior shoulder instability using a case-based approach.

Recent Findings

Arthroscopic Bankart repair is well documented for having successful outcomes in patients with isolated labral tear involvement with minimal bone loss. Latarjet is a generally accepted procedure in patients with 20–30% glenoid bone loss. When bone loss exceeds that which cannot be managed through Latarjet, a range of options exist and are highly dependent upon the extent of osseous deficiency on both the glenoid and humeral sides, surgeon experience, and patient-specific factors. The use of reverse total shoulder arthroplasty for the management of chronic locked shoulder dislocations has been described as a successful management option.

Summary

Treatment options for complex anterior shoulder instability range widely based on patients’ presenting exam, surgical history, amount of glenoid bone loss, size of Hill-Sachs lesion, and surgeon preference. When selecting the appropriate surgical intervention, the treating surgeon must consider the patient history, physical exam, and preoperative imaging along with patient expectations.

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Correspondence to Xinning Li.

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Nathan Olszewski, Michael Gustin, and Emily J. Curry declare that they have no conflict of interest.

Xinning Li reports equity in, and is an editorial board member of, Journal of Medical Insight.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Management of Anterior Shoulder Instability

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Olszewski, N., Gustin, M., Curry, E.J. et al. Management of Complex Anterior Shoulder Instability: a Case-Based Approach. Curr Rev Musculoskelet Med 10, 480–490 (2017). https://doi.org/10.1007/s12178-017-9438-z

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Keywords

  • Anterior shoulder instability
  • Latarjet procedure
  • Eden-Hybinette procedure
  • Bankart repair
  • Remplissage
  • Pectoralis major transfer
  • Reverse total shoulder arthroplasty
  • Critical Glenoid Bone Loss