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Bone-mediated anteroinferior glenohumeral instability

Current concepts

Knochenbedingte anteroinferiore glenohumerale Instabilität

Aktuelle Verfahren

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Abstract

Recurrent anterior shoulder instability is commonly associated with defects of the anterior glenoid rim. Substantial osseous defects significantly diminish the glenohumeral stability and require a bony augmentation, either by a coracoid transfer or free bone grafting procedure. Both reconstructive techniques have been applied for a long time and evaluated biomechanically and clinically. Although neither treatment option has been recognized as clearly superior, both comprise certain advantages and disadvantages. The Latarjet technique enables a biomechanically superior stabilization through the additional sling effect at time zero, but constitutes an extra-anatomical procedure with a broad spectrum and relatively high incidence of complications. Free bone grafting techniques enable an anatomical reconstruction of the glenoid concavity, offer the advantage of an unlimited graft size and show generally less severe and more easily manageable complications. The indications need to be carefully considered depending on the specific defect type, the glenoid track concept in cases of bipolar lesions as well as the individual patient characteristics. For both reconstructive procedures, open and arthroscopic approaches have been described with very good results, allowing a selection based on individual surgical skills and experience levels.

Zusammenfassung

Eine rezidivierende anteriore Schulterinstabilität ist meist mit einem Defekt des anterioren Glenoidrands assoziiert. Große knöcherne Defekte verringern die glenohumerale Stabilität signifikant und bedürfen einer Knochenaugmentation, entweder mittels eines Korakoidtransfers oder eines freien Knochentransplantats. Beide rekonstruktive Verfahren kommen seit Langem zum Einsatz und sind biomechanisch und klinisch erprobt. Obwohl keine der beiden Behandlungsmethoden als eindeutig überlegen anerkannt ist, haben sie jeweils ihre Vor- und Nachteile. Die Latarjet-Technik erlaubt eine biomechanisch überlegene Stabilisierung durch den zusätzlichen Sling-Effekt zum Zeitpunkt Null, stellt jedoch ein extraanatomisches Verfahren mit einem breiten Spektrum und relativ hoher Komplikationsrate dar. Die Operationstechnik mit einem freien Knochentransplantat ermöglicht die anatomische Rekonstruktion der Glenoidkonkavität, bietet den Vorteil einer unbegrenzten Implantatgröße und zeigt generell weniger schwere und einfacher zu behandelnde Komplikationen. Die Indikationen müssen vorsichtig gestellt werden in Abhängigkeit von den spezifischen Defektarten, dem Glenoid-Track-Konzept in Fällen bipolarer Läsionen sowie den individuellen Patientencharakteristika. Für beide rekonstruktiven Verfahren, seien es offene oder arthroskopische Eingriffe, wurden sehr gute Ergebnisse beschrieben, was eine Selektion erlaubt, die auf den individuellen chirurgischen Fähigkeiten und dem Erfahrungslevel basiert.

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Authors and Affiliations

  1. Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland

    A. Lädermann MD

  2. Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205, Geneva, Switzerland

    A. Lädermann MD

  3. Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland

    A. Lädermann MD

  4. Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    E. Böhm & M. Scheibel

  5. Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore

    E. Tay

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A. Lädermann received consultant fees from Wright, Mitek and Medacta. M. Scheibel is a consultant for Arthrex. E. Böhm and E. Tay declare that they have no competing interests.

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

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Lädermann, A., Böhm, E., Tay, E. et al. Bone-mediated anteroinferior glenohumeral instability. Orthopäde 47, 129–138 (2018). https://doi.org/10.1007/s00132-017-3511-6

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