Abstract
There is limited evidence examining glenoid osteotomy as a treatment for posterior shoulder instability. A search of Medline, Embase, PubMed and Cochrane Central Register of Controlled Trials was conducted from the date of origin to 28th November 2019. Nine out of 3,408 retrieved studies met the inclusion criteria and quality was assessed using the Methodological Index for Non-randomized Studies tool. In 356 shoulders, the main indication for osteotomy was excessive glenoid retroversion (greater than or equal to approximately -10°). The mean preoperative glenoid version was -15° (range, -35° to -5°). Post-operatively, the mean glenoid version was -6° (range, -28° to 13°) and an average correction of 10° (range, -1° to 30°) was observed. Range of motion increased significantly in most studies and all standardized outcome scores (Rowe, Constant-Murley, Oxford instability, Japan Shoulder Society Shoulder Instability Scoring and mean shoulder value) improved significantly with high rates of patient satisfaction (85%). A high complication rate (34%, n = 120) was reported post-surgery, with frequent cases of persistent instability (20%, n = 68) and fractures (e.g., glenoid neck and acromion) (4%, n = 12). However, the revision rate was low (0.6%, n = 2). Glenoid osteotomy is an appropriate treatment for posterior shoulder instability secondary to excessive glenoid retroversion. However, the high rate of persistent instability should be considered when making treatment decisions.Level of Evidence: Systematic review; Level 4.
Highlights
Shoulder instability is generally classified relative to direction and duration.[1]
Posterior instability accounts for approximately 2–10% of shoulder instability cases and can manifest itself on a spectrum, ranging from mild subluxation to frank dislocation.[2,3,4,5,6]
This review identified mean glenoid version decreased with glenoid osteotomy with an average correction of 10°
Summary
Shoulder instability is generally classified relative to direction (e.g. anterior, posterior or multidirectional) and duration (e.g. acute, chronic or recurrent).[1]. Burkhead and Rockwood used a rehabilitative program as treatment for 140 unstable shoulders to demonstrate that non-operative treatment for posterior instability is successful in up to 89% of cases.[7] certain risk factors such as increased glenoid retroversion predispose patients to failure of conservative treatment.[6,7] For patients with posterior shoulder instability who have failed prior non-surgical treatments and soft tissue interventions, such as capsulolabral repairs, bony procedures become important. These procedures include posterior bone block or, in patients who have.
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