Glenoid Bone Loss in Athletes

  • Deepak N. Bhatia
  • Joe F. De Beer


Anterior shoulder instability in athletes is a complex problem and necessitates accurate pre- and intra-operative assessment of soft-tissue and bony pathology. Significant bone loss on the glenoid or humeral head predisposes to failure of soft-tissue repair, and bone grafting procedures are necessary to stabilise the shoulder. Recent research has focussed on radiological and arthroscopic assessment of glenoid bone loss, and treatment algorithms have evolved to incorporate newer techniques for optimal outcomes. This chapter describes key concepts that guide diagnosis and management of this complex condition. Essential surgical procedures, and their recent significant modifications are outlined, and the outcomes of various procedures are highlighted.


Shoulder instability Engaging Hill–Sachs Inverted pear glenoid Glenoid track Humeral avulsion glenohumeral ligament Instability severity index score Latarjet procedure Remplissage Double-barrel remplissage Iliac crest graft Labroplasty 


  1. 1.
    Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677–94.CrossRefGoogle Scholar
  2. 2.
    Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am. 2003;85-A(5):878–84.CrossRefGoogle Scholar
  3. 3.
    De Beer J, Bhatia DN. Shoulder injuries in rugby players. Int J Shoulder Surg. 2009;3(1):1–3.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Longo UG, Huijsmans PE, Maffulli N, Denaro V, De Beer JF. Video analysis of the mechanisms of shoulder dislocation in four elite rugby players. J Orthop Sci. 2011;16(4):389–97.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Saito H, Itoi E, Sugaya H, Minagawa H, Yamamoto N, Tuoheti Y. Location of the glenoid defect in shoulders with recurrent anterior dislocation. Am J Sports Med. 2005;33(6):889–93.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Itoi E, Yamamoto N, Kurokawa D, Sano H. Bone loss in anterior instability. Curr Rev Musculoskelet Med. 2013;6(1):88–94.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, Okada K. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elb Surg. 2007;16(5):649–56.CrossRefGoogle Scholar
  8. 8.
    Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med. 1998;26(1):41–5.CrossRefGoogle Scholar
  9. 9.
    Spatschil A, Landsiedl F, Anderl W, et al. Posttraumatic anteriorinferior instability of the shoulder: arthroscopic findings and clinical correlations. Arch Orthop Trauma Surg. 2006;126(4):217–22.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Yiannakopoulos CK, Mataragas E, Antonogiannakis E. A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy. 2007;23(9):985–90.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Buhler M, Gerber C. Shoulder instability related to epileptic seiz- ures. J Shoulder Elb Surg. 2002;11:339–44.CrossRefGoogle Scholar
  12. 12.
    Hardy P. Bony lesions influence on the result of the arthroscopic treatment of gleno-humeral instability. Symposium: shoulder instability limits of arthroscopic surgery: bone deficiency, shrink- age, acute instability. Read at 5th International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress, Auckland, March 10–14, 2003.Google Scholar
  13. 13.
    Miniaci A, Berlet G. Recurrent anterior instability following failed surgical repair: allograft reconstruction of large humeral head defects. J Bone Joint Surg Br. 2001;83(Suppl 1):19–20.Google Scholar
  14. 14.
    Voos JE, Livermore RW, Feeley BT, et al. Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med. 2010;38(2):302–7.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Burkhart SS, De Beer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy. 2002;18(5):488–91.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90–8.CrossRefGoogle Scholar
  17. 17.
    Arrigoni P, Huberty D, Brady PC, Weber IC, Burkhart SS. The value of arthroscopy before an open modified latarjet reconstruction. Arthroscopy. 2008;24(5):514–9.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Bhatia DN, DasGupta B. Surgical treatment of significant glenoid bone defects and associated humeral avulsions of glenohumeral ligament (HAGL) lesions in anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1603–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Bernhardson AS, Bailey JR, Solomon DJ, Stanley M, Provencher MT. Glenoid bone loss in the setting of an anterior labroligamentous periosteal sleeve avulsion tear. Am J Sports Med. 2014;42(9):2136–40.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy. 2008;24(9):1061–73.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Bushnell BD, Creighton RA, Herring MM. The bony apprehension test for instability of the shoulder: a prospective pilot analysis. Arthroscopy. 2008;24(9):974–82.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Edwards TB, Boulahia A, Walch G. Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy. 2003;19(7):732–9.CrossRefGoogle Scholar
  23. 23.
    Jankauskas L, Rüdiger HA, Pfirrmann CW, Jost B, Gerber C. Loss of the sclerotic line of the glenoid on anteroposterior radiographs of the shoulder: a diagnostic sign for an osseous defect of the anterior glenoid rim. J Shoulder Elb Surg. 2010;19(1):151–6.CrossRefGoogle Scholar
  24. 24.
    Markenstein JE, Jaspars KC, van der Hulst VP, Willems WJ. The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT. Skelet Radiol. 2014;43(4):475–83.CrossRefGoogle Scholar
  25. 25.
    Baudi P, Righi P, Bolognesi D, Rivetta S, Rossi Urtoler E, Guicciardi N, Carrara M. How to identify and calculate glenoid bone deficit. Chir Organi Mov. 2005;90:145–52.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Chuang TY, Adams CR, Burkhart SS. Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy. 2008;24:376–82.CrossRefGoogle Scholar
  27. 27.
    Magarelli N, Milano G, Sergio P, Santagada DA, Fabbriciani C, Bonomo L. Intra-observer and interobserver reliability of the ‘Pico’ computed tomography method for quantification of glenoid bone defect in anterior shoulder instability. Skelet Radiol. 2009;38(11):1071–5.CrossRefGoogle Scholar
  28. 28.
    Sugaya H, Kon Y, Tsuchiya A. Arthroscopic repair of glenoid fractures using suture anchors. Arthroscopy. 2005;21:635.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Bhatia DN, De Beer JF. Management of anterior shoulder instability without bone loss: arthroscopic and mini-open techniques. Should Elb. 2011;3:1–7.CrossRefGoogle Scholar
  30. 30.
    Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470–7.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Wolf EM, Arianjam A. Hill-Sachs remplissage, an arthroscopic solution for the engaging Hill-Sachs lesion: 2- to 10-year follow-up and incidence of recurrence. J Shoulder Elb Surg. 2014;23(6):814–20.CrossRefGoogle Scholar
  32. 32.
    Bhatia DN. Double-barrel remplissage: an Arthroscopic all–intra-articular technique using the double-barrel knot for anterior shoulder instability. Arthrosc Tech. 2015;4(1):e65–70. Scholar
  33. 33.
    Young AA, Maia R, Berhouet J, Walch G. Open latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Shoulder Elb Surg. 2011;20(2 Suppl):S61–9.CrossRefGoogle Scholar
  34. 34.
    De Beer JF, Roberts C. Glenoid bone defects--open latarjet with congruent arc modification. Orthop Clin North Am. 2010;41(3):407–15.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Dumont GD, Fogerty S, Rosso C, Lafosse L. The arthroscopic latarjet procedure for anterior shoulder instability: 5-year minimum follow-up. Am J Sports Med. 2014;42(11):2560–6.CrossRefGoogle Scholar
  36. 36.
    Bhatia DN. Arthroscopic latarjet and capsular shift (ALCS) procedure: a new “freehand” technique for anterior shoulder instability associated with significant bone defects. Tech Hand Up Extrem Surg. 2014;19(1):11–7.CrossRefGoogle Scholar
  37. 37.
    Haaker RG, Eickhoff U, Klammer HL. Intraarticular autogenous bone grafting in recurrent shoulder dislocations. Mil Med. 1993;158:164–9.PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Taverna E, D’Ambrosi R, Perfetti C, Garavaglia G. Arthroscopic bone graft procedure for anterior inferior glenohumeral instability. Arthrosc Tech. 2014;3(6):e653–60.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Provencher MT, Ghodadra N, LeClere L, Solomon DJ, Romeo AA. Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft. Arthroscopy. 2009;25:446–52.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Warner JJ, Gill TJ, O’hollerhan JD, Pathare N, Millett PJ. Anatomical glenoid reconstruction for recurrent anterior glenohumeral instability with glenoid deficiency using an autogenous tricortical iliac crest bone graft. Am J Sports Med. 2006;34:205–12.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Bhatia DN. Dual-window subscapularis-sparing approach: a new surgical technique for combined reconstruction of a glenoid bone defect or bankart lesion associated with a HAGL lesion in anterior shoulder instability. Tech Hand Up Extrem Surg. 2012;16(1):30–6.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Burkhart SS, De Beer JF, Barth JR, Cresswell T, Roberts C, Richards DP. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy. 2007;23(10):1033–41.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    De Beer JF, et al. Evaluation of functional outcomes and complications following modified Latarjet reconstruction in athletes with anterior shoulder instability. Should Elb. 2015;7(3):168–73.CrossRefGoogle Scholar
  44. 44.
    Kraus N, Amphansap T, Gerhardt C, Scheibel M. Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elb Surg. 2014;23(11):1700–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Deepak N. Bhatia
    • 1
    • 2
  • Joe F. De Beer
    • 3
  1. 1.Department of Orthopaedic SurgerySeth GS Medical College, and King Edward VII Memorial HospitalMumbaiIndia
  2. 2.SPORTSMEDMumbaiIndia
  3. 3.Cape Shoulder InstituteCape TownSouth Africa

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