Video Details

15:09

Published March 15, 2015

Disclosures

Shoulder and Elbow Glenohumeral Soft Tissue

Management of Glenoid Bone Loss in Anterior Shoulder Instability: A Case Based Approach

Bone defects in the setting of recurrent anterior shoulder instability can be difficult to treat. An intact glenoid articular arc is critical for a stable articulation with the humeral head, and even small losses of the articular congruency can prove detrimental if not surgically addressed. Bone defects of the anterior glenoid are variable, and can consist of acute anterior glenoid rim fractures, partial attritional glenoid bone loss, and varying degrees of larger amounts bone loss. In general, defects less than 15% of the glenoid width can be treated with soft tissue stabilization alone while defects greater than 30% often require autograft or allograft glenoid augmentation. Defects between 15-30% are in an indeterminate zone, and pathology- and patient-specific factors drive the decision making for surgical repair. Smaller defects can often be treated via all-arthroscopic techniques, incorporating the bony fragment whenever possible. Larger defects often require open, arthroscopic-assisted augmentation procedures, such as coracoid transfer or allograft reconstruction. In this video we utilize a case-based approach to describe safe, reproducible, and reliable arthroscopic techniques for safe, reproducible, and reliable surgical techniques for the management of glenoid bone loss in the setting of anterior shoulder instability. Four specific cases are discussed, including a case of an acute traumatic glenoid rim fracture, bone loss of less than 15%, bone loss of 20-25%, and bone loss of 35% of the glenoid surface area. The background, basic science, typical patient presentation, imaging findings, techniques, rehabilitation protocol, and clinical outcomes are reviewed in detail.