State of the art for treatment of bony defects around anterior shoulder instability—the American perspective

Rafael Kakazu,Matthew R Levasseur,Augustus D Mazzocca,Robert A Arciero

doi:10.1007/s11678-021-00631-2

Rafael Kakazu, Matthew R Levasseur + Show 2 more

Open Access

https://doi.org/10.1007/s11678-021-00631-2

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Journal: Obere extremitat	Publication Date: Mar 1, 2021
Citations: 2	License type: CC BY 4.0

Affiliation: University of Connecticut

Abstract

AbstractWhile arthroscopic Bankart repair yields high success rates, bone loss on the glenoid or humeral head can portend a poor outcome. The authors recommend a thorough evaluation including computed tomography (CT) scanning to best evaluate the amount of bone loss. Multiple studies have shown that the outcomes of revision stabilization procedures are inferior to the respective primary procedure; thus, it is of paramount importance to select the correct index procedure to optimize patient outcome. The authors present the American perspective on treating shoulder instability. For patients with a small on-track Hill Sachs lesion and less than 10 % glenoid bone loss, an isolated arthroscopic Bankart repair is appropriate. This procedure is also recommended for bony Bankart lesions, as well as in overhead throwing athletes. With an engaging Hill Sachs lesion and less than 15 % glenoid bone loss, the authors recommend the addition of a remplissage to the arthroscopic Bankart repair. For patients with up to 15 % bone loss or following a failed previous arthroscopic repair, the authors advocate for open Bankart repair. They recommend Latarjet in patients with a non-engaging Hill Sachs lesion greater than 15 % bone loss. Patients with bone loss over 30 % would benefit from bone grafting with iliac crest autograft or distal tibia allograft for stabilization. In summary, the authors believe that the index procedure provides an opportunity to optimize patient outcome and careful consideration of the treatment options is warranted.

Highlights

Anterior shoulder dislocations produce characteristic anteroinferior capsulolabral injuries that are commonly treated with arthroscopic repair; the presence of bone loss either on the glenoid or humeral head can lead to failure of an arthroscopic repair in up to 67% of cases [1]
A recent cadaveric study demonstrated that lesions involving as little as 8–15% of the glenoid combined with a medium-sized Hill Sachs lesion can produce recurrent instability following an isolated Bankart repair [23]
If the Hill Sachs lesion engages with glenoid bone loss less than 15%, an arthroscopic Bankart repair with remplissage is a reasonable option

Summary

Introduction

Anterior shoulder dislocations produce characteristic anteroinferior capsulolabral injuries that are commonly treated with arthroscopic repair; the presence of bone loss either on the glenoid or humeral head can lead to failure of an arthroscopic repair in up to 67% of cases [1]. A recent cadaveric study demonstrated that lesions involving as little as 8–15% of the glenoid combined with a medium-sized Hill Sachs lesion can produce recurrent instability following an isolated Bankart repair [23]. Following strict selection criteria and using a modern surgical technique, Leroux reported a recurrence rate of 8% following arthroscopic stabilization for contact athletes [27] This low failure rate included procedures performed on patients without glenoid or humeral bone loss and utilized the lateral decubitus position with a minimum of three suture anchors. Patients that present with a non-engaging Hill Sachs lesion with greater than 10% bone loss demonstrate inferior outcomes following arthroscopic Bankart repair [4, 5]. The open procedure allows for double row fixation of the capsulolabral complex, capsular plication, and a dual capsular shift involving the inferior and

Conclusions

Findings

Compliance with ethical guidelines