Effect of Posterior Glenoid Bone Loss and Retroversion on Arthroscopic Posterior Glenohumeral Stabilization

2020 ◽  
Vol 48 (11) ◽  
pp. 2621-2627
Author(s):  
Jared A. Wolfe ◽  
Michael Elsenbeck ◽  
Kyle Nappo ◽  
Daniel Christensen ◽  
Robert Waltz ◽  
...  
Keyword(s):  
Bone Loss ◽  
Circle Method ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Bone Deficiency ◽  
Posterior Shoulder ◽  
Deficiency Group ◽  
Glenoid Retroversion

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder instability, but little is known about the incidence or effect of posterior glenoid bone loss. Purpose: To determine the incidence, characteristics, and failure rate of posterior glenoid deficiency in shoulders undergoing isolated arthroscopic posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing isolated posterior labral repair and glenoid-based capsulorrhaphy with suture anchors between 2008 and 2016 at a single institution were identified. Posterior bone deficiency was calculated per the best-fit circle method along the inferior two-thirds of the glenoid by 2 independent observers. Patients were divided into 2 groups: minimal (0%-13.5%) and moderate (>13.5%) posterior bone loss. The primary outcome was reoperation for any reason. The secondary outcomes were military separation and placement on permanent restricted duty attributed to the operative shoulder. Results: A total of 66 shoulders met the inclusion criteria, with 10 going on to reoperation after a median follow-up of 16 months (range, 14-144 months). Of the total shoulders, 86% (57/66) had ≤13.5% bone loss and 14% (9/66) had >13.5%. Patients with moderate posterior glenoid bone loss had significantly greater retroversion (−11.5° vs −4.3°; P = .01). Clinical failure requiring reoperation was seen in 10.5% of patients in the minimal bone deficiency group and 44.4% in the moderate group ( P = .024). There was no difference between groups in rate of military separation or restricted duty. Patients with moderate posterior glenoid bone deficiency were more likely to be experiencing instability instead of pain on initial presentation ( P < .001), were more likely to have a positive Jerk test result ( P = .05), and had increased glenoid retroversion ( P = .01). Conclusion: In shoulders with moderate glenoid bone deficiency (>13.5%) and increased glenoid retroversion, posterior capsulolabral repair alone may result in higher reoperation rates than in shoulders without bone deficiency.

scholarly journals Incidence and Clinical Significance of Posterior Glenoid Deficiency in Patients with Posterior Glenohumeral Instability

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0008
Author(s):  
Michael Elsenbeck ◽  
Jared Wolfe ◽  
Kyle E. Nappo ◽  
Daniel Christensen ◽  
Robert A. Waltz ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Preoperative Evaluation ◽  
Circle Method ◽  
Labral Repair ◽  
Glenohumeral Instability ◽  
Bone Deficiency ◽  
Case Logs ◽  
Deficiency Group ◽  
Reoperation Rates

Objectives: Posterior glenohumeral instability accounts for 10-40% of instability repairs yet the degree posterior bone deficiency contributing to labral repair failure is unclear. The purpose of this study is to determine the incidence, characteristics, and clinical impact of posterior glenohumeral bone deficiency in patients undergoing posterior shoulder stabilization. Methods: All consecutive patients undergoing isolated soft tissue only posterior labral repairs from 2008-2016 at our institution were identified via review of surgical case logs. Posterior bone deficiency was calculated using the best fit circle method along the inferior 2/3 s of the glenoid by two independent observers. The intra-observer and inter-observe reliability ICC of this method was .96 and .86, respectively. Patients were divided into three groups, no bone loss (0-5%), minimal bone loss (5-13.5%) and moderate posterior bone deficit (>13.5%). Our primary outcome, was reoperation for any reason, secondary outcomes were military separation due to the operative shoulder, and placement on permanent restricted duty due to the operative shoulder. Additional comparisons between the groups were made on the basis of preoperative clinical and radiographic characteristics. Results: We identified 66 patients that met our inclusion and exclusion criteria. Our median follow up time was 22 months (range 7-144months). 39 of the 66 patients had no measureable bone deficiency while 18 patients had between 5 and 13.5%, and 9 patients had greater than 13.5%. The greatest amount of bone deficiency in a patient was 27%. The reoperation rates were 7.7% in the no bone deficiency group, 16% in the minimal bone deficiency group, and 33% in the moderate group, this difference was statistically significant (p=.036). There was no difference in rates of military separation, or restricted duty between groups. Additionally, patients with posterior glenoid bone deficiency, were more likely to complain of instability instead of pain on initial presentation (p=.002), and were more likely to have a positive posterior load shift test (p=.027). Conclusion: Posterior glenoid bone deficiency is common and potentially under recognized in patients undergoing surgery for posterior glenohumeral instability with over one-third of our patients having some degree of bone deficiency. In patients with moderate glenoid bone deficiency (>13.5%), soft tissue only stabilization procedures may have higher reoperation rates then in patients without bone deficiency. On preoperative evaluation the primary complaint of instability instead of pain and a positive posterior load shift were predictive of the presence of posterior glenoid bone deficiency.

Glenoid Bone Loss in Posterior Shoulder Instability: Prevalence and Outcomes in Arthroscopic Treatment

2018 ◽  
Vol 46 (5) ◽  
pp. 1053-1057 ◽  
Author(s):  
Adam Hines ◽  
Jay B. Cook ◽  
James S. Shaha ◽  
Kevin Krul ◽  
Steve H. Shaha ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Patient Reported Outcomes ◽  
Glenoid Bone Loss ◽  
Labral Repair ◽  
Arthroscopic Stabilization ◽  
Posterior Instability ◽  
Glenohumeral Instability ◽  
Patient Reported ◽  
Return To Duty

Background: Glenoid bone loss is a well-accepted risk factor for failure after arthroscopic stabilization of anterior glenohumeral instability. Glenoid bone loss in posterior instability has been noted relative to its existence in posterior instability surgery. Its effect on outcomes after arthroscopic stabilization has not been specifically evaluated and reported. Purpose: The purpose was to evaluate the presence of posterior glenoid bone loss in a series of patients who had undergone arthroscopic isolated stabilization of the posterior labrum. Bone loss was then correlated to return-to-duty rates, complications, and validated patient-reported outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective review was conducted at a single military treatment facility over a 4-year period (2010-2013). Patients with primary posterior instability who underwent arthroscopic isolated posterior labral repair were included. Preoperative magnetic resonance imaging was used to calculate posterior glenoid bone loss using a standardized “perfect circle” technique. Demographics, return to duty, complications, and reoperations, as well as outcomes scores including the Single Assessment Numeric Evaluation and the Western Ontario Shoulder Instability Index (WOSI) scores, were obtained. Outcomes were analyzed across all patients based on percentage of posterior glenoid bone loss. Bone loss was then categorized as below or above the subcritical threshold of 13.5% to determine if bone loss effected outcomes similar to what has been shown in anterior instability. Results: There were 43 consecutive patients with primary, isolated posterior instability, and 32 (74.4%) completed WOSI scoring. Mean follow-up was 53.7 months (range, 25-82 months) The mean posterior glenoid bone loss was 7.3% (0%-21.5%). Ten of 32 patients (31%) had no appreciable bone loss. Bone loss exceeded 13.5% in 7 of 32 patients (22%), and 2 patients (6%) exceeded 20% bone loss. Return to full duty or activity was nearly 90% overall. However, those with >13.5%, subcritical glenoid bone loss, were statistically less likely to return to full duty (relative risk = 1.8), but outcomes scores, complications, and revision rates were otherwise not different in those with no or minimal bone loss versus those with more significant amounts. Conclusion: Posterior glenoid bone loss has not previously been evaluated independently relative to patients with shoulder instability repairs. Sixty-nine percent of our patients had measurable bone loss, and 22% had greater than 13.5%, or above subcritical bone loss. While these patients were statistically less likely to return to full duty, the reoperation rate, complications, and patient-reported outcomes between groups were not different.

scholarly journals When to Abandon the Arthroscopic Bankart Repair: A Systematic Review

2020 ◽  
Vol 12 (5) ◽  
pp. 425-430
Author(s):  
Benjamin J. Levy ◽  
Nathan L. Grimm ◽  
Robert A. Arciero
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Study Design ◽  
Humeral Head ◽  
Measurement Techniques ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Arthroscopic Bankart Repair

Context: Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed. Objective: To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature. Data Sources: An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE). Study Selection: Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar). Results: A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking. Conclusion: It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be “on track” if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.

Location of the Glenoid Defect in Shoulders With Recurrent Posterior Glenohumeral Instability

2019 ◽  
Vol 47 (13) ◽  
pp. 3051-3056 ◽  
Author(s):  
Travis J. Dekker ◽  
Liam A. Peebles ◽  
Brandon T. Goldenberg ◽  
Peter J. Millett ◽  
James P. Bradley ◽  
...  
Keyword(s):  
Bone Loss ◽  
Bone Defect ◽  
Shoulder Instability ◽  
Bone Defects ◽  
Posterior Shoulder Instability ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Glenoid Defect ◽  
Posterior Shoulder ◽  
The Mean

Background: Posterior glenoid bone deficiency is an increasingly recognized entity in the setting of recurrent posterior shoulder instability; however, little is known about the subject. Due to the paucity of literature on posterior bone loss, historical comparisons with anterior bone loss may not be fully accurate. Purpose: To systematically describe the morphology of posterior bone defects in the setting of recurrent posterior shoulder instability based on several quantitative parameters, including the mean location, orientation, and extent of bone loss on a clockface model, as well as the angle of the defect relative to the long axis of the glenoid. Study Design: Cross-sectional study; Level of evidence, 4. Methods: Three-dimensional reconstructed computed tomography scans of serially collected patients with a history of recurrent posterior shoulder instability were evaluated by 3 separate reviewers. The posterior glenoid bone defect was characterized using the following measures: (1) the mean lesion location and orientation based on a clockface model with 6 o’clock denoted as inferior and 9 o’clock as directly posterior for all patients; (2) the total extent of the posterior bone defect based on the clockface; and (3) the average angle of the bone loss relative to the long axis of the glenoid. Results: A total of 70 male patients and 1 female patient with a mean age of 29.3 years (range, 24.4-35.1 years) were included in the analysis. The mean clockface location of the posterior glenoid defect originated at 6:44 (range, 4:16-8:12) and extended to a mean of 9:28 (range, 7:02-10:38). The mean extent of the posterior glenoid defect was 2:43 (range, 1:08-4:50), which corresponds to a mean total bone loss arc of 81.5° (range, 34.2°-144.9°), nearly 1 quadrant of the glenoid. Posterior bone loss occurred in a posteroinferior direction at a mean angle of 30.7° (range, 8.0°-80.0°) relative to the long axis of the glenoid. Conclusion: Posterior bone defects in the setting of posterior shoulder instability most commonly occur in the posteroinferior quadrant of the glenoid and extend on average from 6:44 to 9:28 (81.5° total degrees of arc) on a clockface model. Posterior bone loss occurs at a mean of 30° off the long axis of the glenoid in a posteroinferior direction, which is historically different from anterior bone loss, which occurs parallel to the long axis of the glenoid. This study serves to highlight the location and orientation of bone loss that one can expect in a patient with recurrent posterior shoulder instability, although additional work is needed to assess why this develops.

Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20%

2021 ◽  
Vol 49 (4) ◽  
pp. 866-872
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta
Keyword(s):  
Bone Loss ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Rugby Players

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level ( P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively ( P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively ( P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group ( P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group ( P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group ( P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group ( P = .55). Conclusion: In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

scholarly journals Critical Glenoid Bone Loss in Posterior Shoulder Instability

2018 ◽  
Vol 34 (12) ◽  
pp. e2
Author(s):  
Christopher Nacca ◽  
Joseph Gil ◽  
Rohit Badida ◽  
Joseph Crisco ◽  
Brett Owens
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder

scholarly journals Comparison of a Distal Tibial Allograft and Scapular Spinal Autograft for Posterior Shoulder Instability With Glenoid Bone Loss

2018 ◽  
Vol 6 (7) ◽  
pp. 232596711878669 ◽  
Author(s):  
Christopher Nacca ◽  
Joseph A. Gil ◽  
Steven F. DeFroda ◽  
Rohit Badida ◽  
Brett D. Owens
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Posterior Shoulder Instability ◽  
Posterior Shoulder

scholarly journals Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events

2019 ◽  
Vol 47 (5) ◽  
pp. 1082-1089 ◽  
Author(s):  
Jonathan F. Dickens ◽  
Sean E. Slaven ◽  
Kenneth L. Cameron ◽  
Adam M. Pickett ◽  
Matthew Posner ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Instability ◽  
Glenohumeral Instability ◽  
Recurrent Instability ◽  
History Of ◽  
Anterior Glenohumeral Instability ◽  
First Time

Background: Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. Purpose: To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. Study Design: Cohort study; Level of evidence, 2. Methods: The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient’s pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event ( P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability ( P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. Conclusion: Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.

A Clinical Comparison of Linear- and Surface Area–Based Methods of Measuring Glenoid Bone Loss

2018 ◽  
Vol 46 (10) ◽  
pp. 2472-2477 ◽  
Author(s):  
Neil K. Bakshi ◽  
George A. Cibulas ◽  
Jon K. Sekiya ◽  
Asheesh Bedi
Keyword(s):  
Bone Loss ◽  
Surface Area ◽  
Shoulder Instability ◽  
Linear Measurement ◽  
Glenoid Bone Loss ◽  
Area Measurement ◽  
Anterior Shoulder Instability ◽  
3D Ct ◽  
Ct Reconstruction ◽  
Level Of Evidence

Background: The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid bone loss in comparison with surface area–based measurement in patients with recurrent anterior shoulder instability and glenoid bone loss. Hypothesis: Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area–based measurement in patients with anterior shoulder instability and glenoid bone loss. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT) scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical analysis was performed with a paired 2-tailed t test. Results: Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study; 17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage glenoid bone loss calculated with the surface area and linear methods was 12.8% ± 8.0% and 17.5% ± 9.7% ( P < .0001), respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and linear methods was 16.6% ± 7.9% and 23.0% ± 8.0% ( P < .0001), respectively. Conclusion: Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area measurement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used interchangeably and cannot be used with the same critical thresholds for glenoid bone loss.

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