Arthroscopic Management of Anterior Glenoid Bone Loss

JBJS Reviews ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e0049
Author(s):  
Devin Lemmex ◽  
Gabriel Cárdenas ◽  
Matthew Ricks ◽  
Jarret Woodmass ◽  
Mikaël Chelli ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Arthroscopic Management ◽  
Anterior Glenoid

scholarly journals Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect

2021 ◽  
Author(s):  
Jens Wermers ◽  
Benedikt Schliemann ◽  
Michael J. Raschke ◽  
Philipp A. Michel ◽  
Lukas F. Heilmann ◽  
...  
Keyword(s):  
Bone Loss ◽  
Linear Model ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Bony Defect ◽  
Stability Ratio ◽  
Anterior Glenoid ◽  
Shoulder Stability

Abstract Purpose Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. Methods The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. Results Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. Conclusion Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.

scholarly journals Effect of Anterior Glenoid Labral Tears and Glenoid Bone Loss at the NFL Combine on Future NFL Performance

2018 ◽  
Vol 6 (7) ◽  
pp. 232596711878488 ◽  
Author(s):  
Colin P. Murphy ◽  
Salvatore J. Frangiamore ◽  
Sandeep Mannava ◽  
Anthony Sanchez ◽  
Evan R. Beiter ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Labral Tears ◽  
Anterior Glenoid

A Flat Anterior Glenoid Corresponds to Subcritical Glenoid Bone Loss

2019 ◽  
Vol 35 (6) ◽  
pp. 1788-1793 ◽  
Author(s):  
Drew A. Lansdown ◽  
Kevin Wang ◽  
Adam B. Yanke ◽  
Gregory P. Nicholson ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Anterior Glenoid

Accuracy of Currently Available Methods in Quantifying Anterior Glenoid Bone Loss: Controversy Regarding Gold Standard—A Systematic Review

2020 ◽  
Vol 36 (8) ◽  
pp. 2295-2313.e1 ◽  
Author(s):  
Lukas P.E. Verweij ◽  
Alexander A. Schuit ◽  
Gino M.M.J. Kerkhoffs ◽  
Leendert Blankevoort ◽  
Michel P.J. van den Bekerom ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Gold Standard ◽  
Glenoid Bone Loss ◽  
Anterior Glenoid

Critical Value of Anterior Glenoid Bone Loss That Leads to Recurrent Glenohumeral Instability After Arthroscopic Bankart Repair

2017 ◽  
Vol 45 (9) ◽  
pp. 1975-1981 ◽  
Author(s):  
Sang-Jin Shin ◽  
Rag Gyu Kim ◽  
Yoon Sang Jeon ◽  
Tae Hun Kwon
Keyword(s):  
Bone Loss ◽  
Critical Value ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Glenohumeral Instability ◽  
Anterior Glenoid ◽  
Group A ◽  
Surgical Failure ◽  
Group B ◽  
Glenoid Erosion

Background: Generally, a glenoid bone loss greater than 20% to 25% is considered critical for poor surgical outcomes after a soft tissue repair. However, recent studies have suggested that the critical value should be lower. Purpose: To determine the critical value of anterior glenoid bone loss that led to surgical failure in patients with anterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: The study included 169 patients with anterior glenoid erosion. The percentage of glenoid erosion was calculated as the ratio of the glenoid loss width and the glenoid width to the diameter of the outer-fitting circle based on the inferior portion of the glenoid contour. The critical value of the glenoid bone loss was analyzed by means of receiver operating characteristic (ROC) curve analysis. Patients were divided into 2 groups based on the amount of glenoid bone loss: group A (less than the critical value) and group B (more than the critical value). Patients evaluated their shoulder function as a percentage of their preinjury level using the Single Assessment Numeric Evaluation (SANE) score, and postoperative clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score and Rowe score. Surgical failure was defined as the need for revision surgery or the presence of subjective symptoms of instability. Results: The optimal critical value of glenoid bone loss was 17.3% (area under the curve = 0.82; 95% confidence interval, 0.73-0.91; P < .001; sensitivity 75%; specificity 86.6%). Group A and B contained 134 and 35 patients, respectively. Shoulder functional scores were significantly lower in group B than in group A ( P < .001). Five patients (3.7%) in group A and 15 (42.9%) in group B had surgical failure ( P < .001). The SANE score was significantly lower in group B (83.8 ± 12.1) than in group A (92.9 ± 4.7, P = .001). Conclusion: An anterior glenoid bone loss of 17.3% or more with respect to the longest anteroposterior glenoid width should be considered as the critical amount of bone loss that may result in recurrent glenohumeral instability after arthroscopic Bankart repair.

The Effects of Latarjet Reconstruction on Glenohumeral Kinematics in the Presence of Combined Bony Defects

2016 ◽  
Vol 44 (7) ◽  
pp. 1818-1824 ◽  
Author(s):  
Ronak M. Patel ◽  
Piyush Walia ◽  
Lionel Gottschalk ◽  
Matthew Kuklis ◽  
Morgan H. Jones ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Humeral Head ◽  
Outcome Measurement ◽  
Glenoid Bone Loss ◽  
Anterior Dislocation ◽  
Bone Block ◽  
Latarjet Procedure ◽  
Glenoid Defect ◽  
Anterior Glenoid

Background: Recurrent glenohumeral instability is often a result of underlying bony defects in the glenoid and/or humeral head. Anterior glenoid augmentation with a coracoid bone block (ie, Latarjet procedure) has been recommended for glenoid bone loss in the face of recurrent instability. However, no study has investigated the effect of Latarjet augmentation in the setting of both glenoid and humeral head defects (Hill-Sachs defects). Purpose: To evaluate the glenohumeral kinematics of the Latarjet procedure in the presence of combined bony defects. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric specimens void of all surrounding soft tissue were tested at all combinations of glenohumeral abduction (ABD) angles of 20°, 40°, and 60° and 3 external rotation (ER) levels of 0°, 40°, and 80°. Each experiment comprised anterior dislocation by translating the glenoid under a 50-N medial load applied on the humerus, simulating the static load of soft tissue. The primary outcome measurement was defined as the percentage of intact translation (normalized distance to dislocation). Specimens were tested in an intact condition (no defect), with different combinations of defects, and with Latarjet augmentation. The Latarjet procedure was performed for 20% and 30% glenoid defects by transferring the specimen′s coracoid process anterior to the glenoid so that it was flush with the articulating surface. Results: Results depended on the position of the arm. At 20° of ABD and 0° of ER, a 20% glenoid defect decreased the percentage of intact translation regardless of the humeral head defect size ( P ≤ .0001). In this same setting, Latarjet reconstruction restored translation to dislocation greater than the native intact joint for all sizes of humeral head defects. At 60° of ABD and 80° of ER, a 20% glenoid defect led to an overall decrease in translation to dislocation with increasing humeral head defects. While Latarjet augmentation resulted in increased translation to dislocation for all humeral head defect sizes, it was not able to restore translation greater than the native intact joint for large humeral head defects (31% and 44%); the normalized percentages of intact translation to dislocation were 65% and 30%, respectively. Conclusion: These results demonstrate that some degree of translation can be regained for combined bony glenoid and humeral head defects with the Latarjet procedure. However, for humeral defects larger than 31%, the rotational effect of the humeral head defect led to persistent decreased translation and to dislocation despite glenoid augmentation. Thus, directly addressing the humeral defect to restore the articular surface should be considered in these cases. Clinical Relevance: This study provides a critical value limit for combined anterior glenoid bone loss and humeral head defects. While this is a biomechanical study, the results indicate that in patients with humeral head defects greater than 31%, additional humeral-sided surgery may be needed.

Estimation of anterior glenoid bone loss area using the ratio of bone defect length to the distance from posterior glenoid rim to the centre of the glenoid

2016 ◽  
Vol 26 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Sang-Jin Shin ◽  
Bong Jae Jun ◽  
Young Won Koh ◽  
Michelle H. McGarry ◽  
Thay Q. Lee
Keyword(s):  
Bone Loss ◽  
Bone Defect ◽  
Glenoid Bone Loss ◽  
Anterior Glenoid
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