36 - Posterior instability: Open and bone augmentation surgery

Abstract

While more rare than anterior glenohumeral instability, posterior glenohumeral instability has been increasingly recognized as a cause of pain and dysfunction in the active population. Recurrent posterior glenohumeral instability following nonoperative or operative management can be the result of increased glenoid retroversion, posterior glenoid bone loss, capsular injury, soft tissue laxity, and humeral head bone loss. Historically, posterior glenoid bone loss has been addressed with open posterior techniques and posterior glenoid bone augmentation using a variety of graft options. However, advances in arthroscopic techniques have made arthroscopic-assisted posterior glenoid bone augmentation a viable option. Outcomes suggest that open posterior shoulder stabilization procedures and posterior bone augmentation procedures consistently restore stability and allow for return to high-level activities. However, there are concerns with progressive degenerative changes at long-term follow-up regardless of treatment technique. Further studies are warranted to determine risk factors for recurrent instability following standard arthroscopic management of posterior glenohumeral instability in order to determine when open posterior techniques or bone augmentation may provide a more consistent outcome while considering the morbidity and complications associated with open posterior glenohumeral stabilization procedures.