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Surgical considerations for glenoid bone loss in anterior glenohumeral instability: a narrative review

  • Review Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Treatment algorithms may consider many factors like glenoid and humeral bone loss, or scores such as the instability severity index score (ISIS). As most studies only evaluate a part of these factors, there is still no evidence-based consensus estalished. Our study aims to summarize the surgical options for treatment of glenoid bone loss (GBL) in anterior shoulder instability.

Methods

Based on the current available literature, surgical options including Bankart repair and glenoid bone augmentation should be considered while taking into consideration the degree of bone loss which has been divided into < 10%, 10–20% and > 20%.

Results

There are many new techniques evolving including arthroscopic anatomic glenoid reconstruction with bone blocks.

Conclusion

Future long-term outcome studies and randomized controlled trials comparing established techniques will be needed for new evidence-based treatment algorithms.

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Availability of data and materials

All relevant data for the research are included in the manuscript.

Abbreviations

AGR:

Anatomic glenoid reconstruction

AAGR:

Arthroscopic anatomic glenoid reconstruction

ARIF:

Arthroscopic reduction and internal fixation

DTA:

Distal tibial allograft

GBL:

Glenoid bone loss

HSL:

Hill-Sachs lesion

ICBG:

Iliac crest bone graft

ICBGT:

Iliac crest bone graft transfer

ISIS:

Instability severity index score

OA:

Osteoarthritis

ORIF:

Open reduction and internal fixation

SLAP:

Superior labrum anterior posterior

References

  1. Giacomo GD, Piscitelli L, Pugliese M. The role of bone in glenohumeral stability. EFORT Open Rev. 2018;3(12):632–40. https://doi.org/10.1302/2058-5241.3.180028.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bois AJ, Fening SD, Polster J, Jones MH, Miniaci A. Quantifying glenoid bone loss in anterior shoulder instability: reliability and accuracy of 2-dimensional and 3-dimensional computed tomography measurement techniques. Am J Sports Med. 2012;40(11):2569–77. https://doi.org/10.1177/0363546512458247.

    Article  PubMed  Google Scholar 

  3. Nakagawa S, Mizuno N, Hiramatsu K, Tachibana Y, Mae T. Absorption of the bone fragment in shoulders with bony Bankart lesions caused by recurrent anterior dislocations or subluxations: when does it occur? Am J Sports Med. 2013;41(6):1380–6. https://doi.org/10.1177/0363546513483087.

    Article  PubMed  Google Scholar 

  4. Itoi E. “On-track” and “off-track” shoulder lesions. EFORT Open Rev. 2017;2(8):343–51. https://doi.org/10.1302/2058-5241.2.170007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Provencher MT, Bhati S, Ghodadra NS, Grumet RC, Bach Jr BR, Dewing CB, LeClere L, Romeo AA. Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Joint Surg Am. 2010;92(Suppl 2):133–51. https://doi.org/10.2106/JBJS.J.00906.

    Article  PubMed  Google Scholar 

  6. Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, Verma NN. Management of recurrent anterior shoulder instability with bipolar bone loss: a systematic review to assess critical bone loss amounts. Am J Sports Med. 2019;47(10):2484–93. https://doi.org/10.1177/0363546518791555.

    Article  PubMed  Google Scholar 

  7. 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 Am. 2007;89(11):1470–7. https://doi.org/10.1302/0301-620X.89B11.18962.

    Article  CAS  Google Scholar 

  8. Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E, Walch G, Steinmann SP. The stabilizing mechanism of the Latarjet Procedure: a cadaveric study. J Bone Joint Surg Am. 2013;95(15):1390–7. https://doi.org/10.2106/JBJS.L.00777.

    Article  PubMed  Google Scholar 

  9. Sahu D. Capsular repair is not an important part of the Latarjet-Walch procedure. J Shoulder Elbow Surg. 2022;31(5):948–56. https://doi.org/10.1016/j.jse.2021.10.030.

    Article  PubMed  Google Scholar 

  10. Boileau P, Mercier N, Old J. Arthroscopic Bankart-Bristow-Latarjet (2B3) procedure: how to do it and tricks to make it easier and safe. Orthop Clin N Am. 2010;41(3):381–92. https://doi.org/10.1016/j.ocl.2010.03.005.

    Article  Google Scholar 

  11. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am. 1998;80(6):841–52. https://doi.org/10.2106/00004623-199806000-00008.

    Article  CAS  PubMed  Google Scholar 

  12. Kukkonen J, Elamo S, Flinkkilä T, Paloneva J, Mäntysaari M, Joukainen A, Lehtinen J, Lepola V, Holstila M, Kauko T, Aarimaa V, FINNISH (Finnish Instability Shoulder Study) Investigators. Arthroscopic Bankart versus open Latarjet as a primary operative treatment for traumatic anteroinferior instability in young males: a randomised controlled trial with 2-year follow-up. Br J Sports Med. 2022;56(6):327–32. https://doi.org/10.1136/bjsports-2021-104028.

    Article  PubMed  Google Scholar 

  13. Imam MA, Shehata MSA, Martin A, Attia H, Sinokrot M, Bahbah EI, Gwilym S, Jacob J, Narvani AA, Meyer DC. Bankart repair versus Latarjet procedure for recurrent anterior shoulder instability: a systematic review and meta-analysis of 3275 shoulders. Am J Sports Med. 2021;49(7):1945–53. https://doi.org/10.1177/0363546520962082.

    Article  PubMed  Google Scholar 

  14. Hovelius L, Saeboe M. Neer Award 2008: Arthropathy after primary anterior shoulder dislocation–223 shoulders prospectively followed up for twenty-five years. J Shoulder Elbow Surg. 2009;18(3):339–47. https://doi.org/10.1016/j.jse.2008.11.004.

    Article  PubMed  Google Scholar 

  15. Hovelius L, Sandström B, Olofsson A, Svensson O, Rahme H. The effect of capsular repair, bone block healing, and position on the results of the Bristow-Latarjet procedure (study III): long-term follow-up in 319 shoulders. J Shoulder Elbow Surg. 2012;21(5):647–60. https://doi.org/10.1016/j.jse.2011.03.020.

    Article  PubMed  Google Scholar 

  16. Boileau P, Thélu CÉ, Mercier N, Ohl X, Houghton-Clemmey R, Carles M, Trojani C. Arthroscopic Bristow-Latarjet combined with Bankart repair restores shoulder stability in patients with glenoid bone loss. Clin Orthop Relat R. 2014;472(8):2413–24. https://doi.org/10.1007/s11999-014-3691-x.

    Article  Google Scholar 

  17. Domos P, Lunini E, Walch G. Contraindications and complications of the Latarjet procedure. Should Elb. 2018;10(1):15–24. https://doi.org/10.1177/1758573217728716.

    Article  Google Scholar 

  18. Gupta A, Delaney R, Petkin K, et al. Complications of the Latarjet procedure. Curr Rev Musculoskelet Med. 2015;8:59–66.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Boileau P, Duysens C, Saliken D, Lemmex DB, Bonnevialle N. All-arthroscopic, guided Eden-Hybbinette procedure using suture-button fixation for revision of failed Latarjet. J Shoulder Elbow Surg. 2019;28(11):e377–88. https://doi.org/10.1016/j.jse.2019.03.022.

    Article  PubMed  Google Scholar 

  20. Xu J, Liu H, Lu W, Deng Z, Zhu W, Peng L, Ouyang K, Li H, Wang D. Modified arthroscopic latarjet procedure: suture-button fixation achieves excellent remodeling at 3-year follow-up. Am J Sports Med. 2020;48(1):39–47. https://doi.org/10.1177/0363546519887959.

    Article  PubMed  Google Scholar 

  21. Provencher MT, Aman ZS, LaPrade CM, Bernhardson AS, Moatshe G, Storac HW, Chahla J, Turnbull TL, LaPrade RF. Biomechanical comparison of screw fixation versus a cortical button and self-tensioning suture for the Latarjet procedure. Orthop J Sports Med. 2018;6(6):2325967118777842. https://doi.org/10.1177/2325967118777842.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Boileau P, Saliken D, Gendre P, Seeto BL, d’Ollonne T, Gonzalez JF, Bronsard N. Arthroscopic Latarjet: suture-button fixation is a safe and reliable alternative to screw fixation. Arthroscopy. 2019;35(4):1050–61. https://doi.org/10.1016/j.arthro.2018.11.012.

    Article  PubMed  Google Scholar 

  23. Rouxel Y, Rolland E, Saillant G. Postoperative recurrence: results of surgical revisions. Rev Chir Orthop Reparatrice Appar Mot. 2000;86(Suppl 1):137–47.

    PubMed  Google Scholar 

  24. Lunn JV, Castellano-Rosa J, Walch G. Recurrent anterior dislocation after the Latarjet procedure: outcome after revision using a modified Eden-Hybinette operation. J Shoulder Elbow Surg. 2008;17(5):744–50. https://doi.org/10.1016/j.jse.2008.03.002.

    Article  PubMed  Google Scholar 

  25. Moroder P, Schulz E, Wierer G, Auffarth A, Habermeyer P, Resch H, Tauber M. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg. 2019;28(7):1298–307. https://doi.org/10.1016/j.jse.2019.03.035.

    Article  PubMed  Google Scholar 

  26. 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(4):446–52. https://doi.org/10.1016/j.arthro.2008.10.017.

    Article  PubMed  Google Scholar 

  27. Provencher MT, Frank RM, Golijanin P, Gross D, Cole BJ, Verma NN, Romeo AA. Distal Tibia allograft glenoid reconstruction in recurrent anterior shoulder instability: clinical and radiographic outcomes. Arthroscopy. 2017;33(5):891–7. https://doi.org/10.1016/j.arthro.2016.09.029.

    Article  PubMed  Google Scholar 

  28. Frank RM, Romeo AA, Richardson C, Sumner S, Verma NN, Cole BJ, Nicholson GP, Provencher MT. Outcomes of Latarjet versus distal tibia allograft for anterior shoulder instability repair: a matched cohort analysis. Am J Sports Med. 2018;46(5):1030–8. https://doi.org/10.1177/0363546517744203.

    Article  PubMed  Google Scholar 

  29. Taverna E, Golanò P, Pascale V, Battistella F. An arthroscopic bone graft procedure for treating anterior-inferior glenohumeral instability. Knee Surg Sports Traumatol Arthrosc. 2008;16(9):872–5. https://doi.org/10.1007/s00167-008-0541-y.

    Article  CAS  PubMed  Google Scholar 

  30. Scheibel M, Kraus N, Diederichs G, Haas NP. Arthroscopic reconstruction of chronic anteroinferior glenoid defect using an autologous tricortical iliac crest bone grafting technique. Arch Orthop Trauma Surg. 2008;128(11):1295–300. https://doi.org/10.1007/s00402-007-0509-2.

    Article  PubMed  Google Scholar 

  31. Fortun CM, Wong I, Burns JP. Arthroscopic iliac crest bone grafting to the anterior glenoid. Arthrosc Tech. 2016;5(4):e907–12. https://doi.org/10.1016/j.eats.2016.04.011.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wong IH, Urquhart N. Arthroscopic anatomic glenoid reconstruction without subscapularis split. Arthrosc Tech. 2015;4(5):e449–56. https://doi.org/10.1016/j.eats.2015.04.005.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Moga I, Konstantinidis G, Coady C, Ghosh S, Wong IH. Arthroscopic anatomic glenoid reconstruction: analysis of the learning curve. Orthop J Sports Med. 2018;6(11):2325967118807906. https://doi.org/10.1177/2325967118807906.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wong IH, King JP, Boyd G, Mitchell M, Coady C. Radiographic analysis of glenoid size and shape after arthroscopic coracoid autograft versus distal tibial allograft in the treatment of anterior shoulder instability. Am J Sports Med. 2018;46(11):2717–24. https://doi.org/10.1177/0363546518789348.

    Article  PubMed  Google Scholar 

  35. Tucker A, Ma J, Sparavalo S, Coady CM, Wong I. Arthroscopic anatomic glenoid reconstruction has a lower rate of recurrent instability compared to arthroscopic Bankart repair while otherwise maintaining a similar complication and safety profile. JISAKOS. 2022;S2059-7754(22)00066-9. https://doi.org/10.1016/j.jisako.2022.05.003

    Article  PubMed  Google Scholar 

  36. McNeil D, Coady C, Wong IH. Arthroscopic anatomic glenoid reconstruction in lateral decubitus position using allograft with nonrigid fixation. Arthrosc Tech. 2018;7(11):e1115–21. https://doi.org/10.1016/j.eats.2018.07.007.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Iizawa N, Yoneda M, Yamada S, Mizuno N, Goto K, Iwashita S, Mae T, Hashiguchi H, Takai S. Benefits of bone graft augmentation to arthroscopic Bankart repair for recurrent anterior shoulder instability with glenoid bone loss. Knee Surg Sports Traumatol Arthrosc. 2020;28(7):2325–33. https://doi.org/10.1007/s00167-019-05746-2.

    Article  PubMed  Google Scholar 

  38. Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719–25. https://doi.org/10.1177/0363546515578250.

    Article  PubMed  Google Scholar 

  39. Komnos GA, Banios K, Liantsis A, Alexiou K, Varitimidis S, Bareka M, Hantes ME. Results of arthroscopic bankart repair in recreational athletes and laborers: a retrospective study with 5 to 14 years of follow-up. Orthop J Sports Med. 2019;7(11):2325967119881648. https://doi.org/10.1177/2325967119881648.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Nakagawa S, Mae T, Yoneda K, Kinugasa K, Nakamura H. Influence of glenoid defect size and bone fragment size on the clinical outcome after arthroscopic bankart repair in male collision/contact athletes. Am J Sports Med. 2017;45(9):1967–74. https://doi.org/10.1177/0363546517700864.

    Article  PubMed  Google Scholar 

  41. Thomazeau H, Courage O, Barth J, Pélégri C, Charousset C, Lespagnol F, Nourissat G, Audebert S, Guillo S, Toussaint B, Lafosse L, Bradel J, Veillard D, Boileau P. Can we improve the indication for Bankart arthroscopic repair? A preliminary clinical study using the ISIS score. Orthop Traumatol Surg Res. 2010;96(8 Suppl):S77–83. https://doi.org/10.1016/j.otsr.2010.09.007.

    Article  CAS  PubMed  Google Scholar 

  42. Privitera DM, Sinz NJ, Miller LR, Siegel EJ, Solberg MJ, Daniels SD, Higgins LD. Clinical outcomes following the latarjet procedure in contact and collision athletes. J Bone Joint Surg Am. 2018;100(6):459–65. https://doi.org/10.2106/JBJS.17.00566.

    Article  PubMed  Google Scholar 

  43. Moroder P, Damm P, Wierer G, Böhm E, Minkus M, Plachel F, Märdian S, Scheibel M, Khatamirad M. Challenging the current concept of critical glenoid bone loss in shoulder instability: does the size measurement really tell it all? Am J Sports Med. 2019;47(3):688–94. https://doi.org/10.1177/0363546518819102.

    Article  PubMed  Google Scholar 

  44. Lynch JR, Clinton JM, Dewing CB, Warme WJ, Matsen FA. Treatment of osseous defects associated with anterior shoulder instability. J Shoulder Elbow Surg. 2009;18(2):317–28. https://doi.org/10.1016/j.jse.2008.10.013.

    Article  PubMed  Google Scholar 

  45. Klemt C, Toderita D, Nolte D, Federico ED, Reilly P, Bull A. The critical size of a defect in the glenoid causing anterior instability of the shoulder after a Bankart repair, under physiological joint loading. Bone Joint J. 2019;101(1):68–74. https://doi.org/10.1302/0301-620X.101B1.BJJ-2018-0974.R1.

    Article  PubMed  Google Scholar 

  46. Yamamoto N, Muraki T, Sperling JW, Steinmann SP, Cofield RH, Itoi E, An KN. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am. 2010;92(11):2059–66. https://doi.org/10.2106/JBJS.I.00261.

    Article  PubMed  Google Scholar 

  47. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35–46. https://doi.org/10.2106/00004623-200001000-00005.

    Article  CAS  PubMed  Google Scholar 

  48. Burkhart SS, Beer JFD. 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. https://doi.org/10.1053/jars.2000.17715.

    Article  CAS  PubMed  Google Scholar 

  49. 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. https://doi.org/10.1177/03635465980260012301.

    Article  CAS  PubMed  Google Scholar 

  50. Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755–63. https://doi.org/10.2106/JBJS.E.00817.

    Article  PubMed  Google Scholar 

  51. Greis PE, Scuderi MG, Mohr A, Bachus KN, Burks RT. Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid. J Shoulder Elbow Surg. 2002;11(5):442–51. https://doi.org/10.1067/mse.2002.124526.

    Article  PubMed  Google Scholar 

  52. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy. 2004;20(2):169–74. https://doi.org/10.1016/j.arthro.2003.11.036.

    Article  PubMed  Google Scholar 

  53. Gottschalk LJ, Walia P, Patel RM, Kuklis M, Jones MH, Fening SD, Miniaci A. Stability of the glenohumeral joint with combined humeral head and glenoid defects: a cadaveric study. Am J Sports Med. 2016;44:933–40. https://doi.org/10.1177/0363546515624914.

    Article  PubMed  Google Scholar 

  54. Calvo E, Delgado C. Management of off-track Hill-Sachs lesions in anterior glenohumeral instability. J Exp Orthop. 2023;10(1):30. https://doi.org/10.1186/s40634-023-00588-x.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Longo UG, Loppini M, Rizzello G, Ciuffreda M, Berton A, Maffulli N, Denaro V. Remplissage, humeral osteochondral grafts, weber osteotomy, and shoulder arthroplasty for the management of humeral bone defects in shoulder instability: systematic review and quantitative synthesis of the literature. Arthroscopy. 2014;30(12):1650–66. https://doi.org/10.1016/j.arthro.2014.06.010.

    Article  PubMed  Google Scholar 

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Acknowledgements

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Funding

This study was supported by the Guangxi Natural Science Foundation (2020GXNSFBA297089), National Natural Science Foundation of China (82102632, 82160412), Guangdong Basic and Applied Basic Research Foundation (2021A1515220030), Medical Research Fund by Guangdong Provincial Health Commission (B2019085), Shenzhen Science and Technology Project (RCYX20210609103902019) and Liuzhou Science and Technology Project (2021CBB0106).

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Authors and Affiliations

  1. Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, 518035, Guangdong, China

    Zhenhan Deng, Wei Lu & Jingyue Su

  2. Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China

    Jian Xu

  3. Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China

    Cailong Liu, Lichuang Wu & Yiheng Ye

  4. Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China

    Shuguang Gao

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  1. Zhenhan Deng
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Contributions

All authors contributed to the study conception and design. ZD and JX contributed to the conception and design of this review article. WL, CL and SG contributed to literature research. LW, YY and JS contributed to data collection. ZD drafted the paper. JX revised the paper. ZD and JX were responsible funding collection. All authors read and approved the final manuscript.

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Correspondence to Jian Xu.

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Deng, Z., Lu, W., Liu, C. et al. Surgical considerations for glenoid bone loss in anterior glenohumeral instability: a narrative review. Eur J Trauma Emerg Surg 50, 395–403 (2024). https://doi.org/10.1007/s00068-023-02357-y

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