Glenoid Bone Defects Research Articles

Glenoid bone loss in shoulder arthroplasty: a narrative review.

Crucial to the success of any total or reverse shoulder arthroplasty (RSA) is the stability of the glenoid component fixation. Instability can lead to early implant failure and unsatisfactory results. Patients often present with varying forms of glenoid bone loss (GBL) in both the primary and revision settings, which can be a challenge for the treating surgeon. Severe cases of GBL can increase the risk of potential complications and diminish implant longevity. The use of the reverse total shoulder replacement has been particularly helpful when addressing significant glenoid bony defects. Various approaches have been proposed to deal with GBL, all of which require an individualized assessment of the specifics of the defect in order to provide maximal fixation and thereby optimize the longevity of the shoulder arthroplasty. This article aims to review the recent literature on GBL in shoulder arthroplasty to provide guidance when considering treatment based on the best available evidence. PubMed, MEDLINE, EMBASE, AccessMedicine, ClinicalKey, DynaMed, and Micromedex were queried for publications utilizing the following keywords: "glenoid bone loss" AND "glenoid bone deficiency" AND "shoulder arthroplasty" AND "classification". The search was restricted to research published between 2004 and 2023. There were no restrictions on study type or language. GBL should be critically evaluated prior to undertaking total shoulder arthroplasty (TSA). The treating surgeon should be aware of various methods of addressing bone defects. The use of TSA is increasing to address various shoulder pathologies. Addressing glenoid bone defects is of critical importance to maximize the longevity and outcome of TSA.

Glenoid segmentation from computed tomography scans based on a 2-stage deep learning model for glenoid bone loss evaluation.

The best-fitting circle drawn by computed tomography (CT) reconstruction of the en face view of the glenoid bone to measure the bone defect is widely used in clinical application. However, there are still some limitations in practical application, which can prevent the achievement of accurate measurements. This study aimed to accurately and automatically segment the glenoid from CT scans based on a 2-stage deep learning model and to quantitatively measure the glenoid bone defect. Patients who were referred to our institution between June 2018 and February 2022 were retrospectively reviewed. The dislocation group consisted of 237 patients with a history of ≥2 unilateral shoulder dislocations within 2 years. The control group consisted of 248 individuals with no history of shoulder dislocation, shoulder developmental deformity, or other disease that may lead to abnormal morphology of the glenoid. All patients underwent CT examination with a 1-mm slice thickness and a 1-mm increment, including complete imaging of the bilateral glenoid. A residual neural network (ResNet) location model and a U-Net bone segmentation model were constructed to develop an automated segmentation model for the glenoid from CT scans. The data set was randomly divided into training (201 of 248) and test (47 of 248) data sets of control-group data and training (190 of 237) and test (47 of 237) data sets of dislocation-group data. The accuracy of the stage 1 (glenoid location) model, the mean intersection-over-union value of the stage 2 (glenoid segmentation) model, and the glenoid volume error were used to assess the performance of the model. The R2 value and Lin concordance correlation coefficient were used to assess the correlation between the prediction and the gold standard. A total of 73,805 images were obtained after the labeling process, and each image was composed of CT images of the glenoid and its corresponding mask. The average overall accuracy of stage 1 was 99.28%; the average mean intersection-over-union value of stage 2 was 0.96. The average glenoid volume error between the predicted and true values was 9.33%. The R2 values of the predicted and true values of glenoid volume and glenoid bone loss (GBL) were 0.87 and 0.91, respectively. The Lin concordance correlation coefficient value of the predicted and true values of glenoid volume and GBL were 0.93 and 0.95, respectively. The 2-stage model in this study showed a good performance in glenoid bone segmentation from CT scans and could quantitatively measure GBL, providing a data reference for subsequent clinical treatment.

Correlation of Glenoid Concavity With Surgical Failure After Arthroscopic Stabilization for Recurrent Anterior Shoulder Instability

Background: Glenoid concavity compression by rotator cuff muscle contraction is one of the key mechanisms in the stability of the glenohumeral joint. Purpose/Hypothesis: The purpose of this study was to evaluate the effects of glenoid concavity, as represented by the bony shoulder stability ratio (BSSR) and other factors, including glenoid bone defect size, on the surgical failure of arthroscopic stabilization procedures for recurrent anterior shoulder instability. The authors also aimed to determine the critical value of BSSR. It was hypothesized that both glenoid concavity and glenoid bone defect size would be correlated with surgical failure, with glenoid concavity having a stronger correlation. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 120 patients who underwent arthroscopic stabilization procedures for recurrent anterior shoulder instability were included. Patients with bony Bankart lesions were excluded to eliminate the postoperative effects of bony fragment restoration on the glenoid concavity. For each patient, variable factors including BSSR, glenoid bone defect size, presence of off-track Hill-Sachs lesions, and age at first dislocation were recorded. Chi-square analysis and Student t test were performed to analyze the effect of each variable on surgical failure. Multivariate logistic regression analysis was used to determine the combined effect of >2 variables on surgical failure. The critical value of BSSR was analyzed using a receiver operating characteristic curve. Results: Nine patients (7.5%) had recurrent instability requiring revision surgery. BSSR (patients with recurrence, 18.6% ± 19.4%; patients without recurrence, 41.8% ± 10.5%; P = .01), glenoid bone defect size (17.5% ± 3.6% vs 11.7% ± 7.0%; P = .02), age at the time of first dislocation (18.8 ± 3.9 years vs 22.0 ± 6.5 years; P = .04), and number of suture anchors used (4.1 ± 0.3 vs 5.8 ± 1.6; P < .001) showed significant differences between patients with and without surgical failure. Multivariate logistic regression analysis revealed surgical failure to be correlated with BSSR (odds ratio, 0.849; P = .02) and the number of suture anchors used (odds ratio, 0.070; P = .03). The critical value of BSSR was 29.3% (area under the curve, 0.84; 95% CI, 0.67-1.00; P < .001; sensitivity, 78%; specificity, 93%). Conclusion: Glenoid concavity is strongly correlated with surgical failure after arthroscopic stabilization procedures for anterior shoulder instability. The value of BSSR reflects shoulder instability caused by glenoid bone morphology more accurately than glenoid bone defect size.

Clinical and radiologic outcomes of Lima ProMade custom 3D-printed glenoid components in primary and revision reverse total shoulder arthroplasty with severe glenoid bone loss: a minimum 2-year follow-up.

The purpose of this study is to report the clinical and radiologic outcomes of patients undergoing primary or revision reverse total shoulder arthroplasty using custom 3D-printed components to manage severe glenoid bone loss with a minimum of 2-year follow-up. Following ethical approval, patients were identified and invited to participate. Inclusion criteria were (1) severe glenoid bone loss necessitating the need for custom implants and (2) patients with definitive glenoid and humeral components implanted more than 2 years prior. Included patients underwent clinical assessment using the Oxford Shoulder Score (OSS), Constant-Murley score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH). Radiographic assessment included anteroposterior and axial projections. Patients were invited to attend a computed tomography (CT) scan to confirm osseointegration. Statistical analysis used descriptive statistics (mean and standard deviation [SD]) and paired t test for parametric data. Eleven patients declined to participate. Five patients were deceased prior to study commencement, leaving 42 remaining patients in this analysis. Three patients had revision surgery before the 2-year follow-up; of these, 2 retained their custom glenoid components. Mean follow-up was 31.6 months from surgery (range 24-52 months). All 4 scores improved: OSS from a mean 15 (SD8.4) to 36 (SD12) (P<.001), Constant-Murley score from a mean 15 (SD11.2) to 52 (SD20.1) (P<.001), QuickDASH from a mean 70 (SD21) to 31 (SD24.8) (P=.004), and the ASES score from a mean 22 (SD17.8) to 71 (SD23.3) (P=.007). Radiologic evaluation demonstrated good osseointegration in all but 1 included patient. The utility of custom 3D-printed components for managing severe glenoid bone loss in primary and revision reverse total shoulder arthroplasty yields significant clinical improvements in this complex cohort. Large complex glenoid bone defects can be managed successfully with custom 3D-printed glenoid components.

Arthroscopic Xenograft With Cerclage Fixation: A Method for Glenoid Bone Loss Reconstruction With Cerclage Fixation Using a Specific Posterior Guide

Large glenoid bone defects are closely associated with high failure rates after arthroscopic Bankart repair in chronic anterior shoulder instability; therefore nowadays the glenoid bone grafting reconstruction procedure is strictly recommended. On the contrary, the optimal grafting procedure is still controversial because there is considerable concern about the resorption rate of allografts, donor site morbidity of the autografts, and sequelae caused by the use of metal fixation devices in proximity of the shoulder joint. We describe an all-arthroscopic technique for anatomic reconstruction of the glenoid that uses a previously shaped xenograft assembled with a metal-free fixation device using 2 ultra-high-strength sutures (FiberTape Cerclage System; Arthrex, Naples, FL), using a specific posterior guide (Arthrex, Naples, FL) in combination with upper third subscapularis augmentation.

Induction of Osteogenesis After BMP-2 Injection in Rabbit Shoulders: A Novel Strategy for Managing Glenoid Bone Defect Associated with Anterior Shoulder Instability

Background: Bone morphogenic protein-2 (BMP-2) has been shown to promote bone formation. The purpose of this research was to determine if an injectable form of BMP-2 could induce bone formation in anteroinferior glenoid bone defects, which is a critical factor of anterior shoulder instability. The purpose of this study was to investigate bone formation in rabbit shoulders following BMP-2 injection into the anterior capsulolabral complex. We hypothesized that the amount of new bone would be greater in rabbit shoulders injected with BMP-2 than in those injected with normal saline. Methods: An experimental study was conducted on 40 shoulders of 20 mature rabbits. Twenty right shoulders were allocated to four groups according to injection dose (5 µg or 10 µg) and follow-up period after injection (4 or 8 weeks). Twenty left shoulders were injected with normal saline as controls. At 4 or 8 weeks after injection, all rabbits were sacrificed, and bone volumes, densities, and locations of bone formation were evaluated using micro-computed tomography (micro-CT). Histologic analysis was performed on all 40 shoulders. Results: Shoulders injected with BMP-2 showed significantly more bone formation than control shoulders in all treated groups (58.6 ± 60.5 mm3 vs. 25.6 ± 32.6 mm3, p = 0.001). Moreover, bone formation increased with dose and follow-up. Locations of bone formation were the lesser tuberosity, greater tuberosity, and anterior capsulolabral complex. Histologic analysis confirmed the micro-CT-detected bone formation by revealing the presence of activated osteocytes, abundant osteoblastic rimming, and woven bone matrix. Conclusion: The study confirms that BMP-2 injection into the anterior capsulolabral complex of rabbit shoulders promotes new bone formation in adjacent soft tissue areas. Study Design: Controlled laboratory study.

Femoral head allograft for glenoid bone loss in primary reverse shoulder arthroplasty: functional and radiologic outcomes

Several techniques have been adopted during primary reverse shoulder arthroplasty (RSA) to manage glenoid bone defect. Among bone grafts, humeral head autograft is currently the mainstream option. However, autologous humeral heads may be unavailable or inadequate and allografts may be a viable alternative. The aim of the present study was to evaluate the functional and radiological outcomes of femoral head allografts for glenoid bone defects in primary RSA. We conducted a retrospective study with prospective data collection enrolling 20 consecutive patients who underwent RSA with femoral head allografts for glenoid bone defects. Indications for surgery were eccentric cuff tear arthropathy in 10 (50%) cases, concentric osteoarthritis in 9 (45%) cases, and fracture sequelae in one (5%) case. Each patient was evaluated preoperatively and at follow-up by X-ray and computed tomography (CT) and by assessing the range of motion (ROM) and the Constant-Murley score (CMS). A CT-based software, a patient-specific 3D model of the scapula, and patient specific instrumentation were used to shape the graft and to assess the position of K-wire for central peg. Postoperatively, CT scans were used to identify graft incorporation and resorption. After a median follow-up of 26.5 months (24-38), ROM and CMS showed a statistically significant improvement (all p=0.001). The median measures of the graft were as follows: 28 mm (28-29) for diameter, 22° (10°-31°) for angle, 4 mm (2-8 mm) for minimum thickness, and 15 mm (11-21 mm) for maximum thickness. Before the surgery, the median glenoid version was 21.8° (16.5°-33.5°) for the retroverted glenoids and -13.5° (-23° to -12°) for the anteverted glenoids. At the follow-up, the median postoperative baseplate retroversion was 5.7° (2.2°- 1.5°) (p=0.001), and this value was close to the 4° retroversion planned on the preoperative CT-based software. Postoperative major complications were noted in four patients: two dislocations, one baseplate failure following a high-energy trauma, and one septic baseplate failure. Partial graft resorption without glenoid component failure was observed in three cases that did not require revision surgery. The femoral head allograft for glenoid bone loss in primary RSA restores shoulder function with CMS values comparable to those of sex- and age-matched healthy individuals. A high rate of incorporation of the graft and satisfactory correction of the glenoid version can be expected after surgery. The management of glenoid bone defects remains a challenging procedure, and a 15% risk of major complication must be considered.

Effect of Postoperative Orthosis on Clinical Outcomes after Rotator Cuff and Glenoid Bone Defect Repair

Effect of Postoperative Orthosis on Clinical Outcomes after Rotator Cuff and Glenoid Bone Defect Repair

The Influence of Glenoid Bone Loss and Graft Positioning on Graft and Cartilage Contact Pressures After the Latarjet Procedure

Background: Glenohumeral joint contact loading before and after glenoid bone grafting for recurrent anterior instability remains poorly understood. Purpose: To develop a computational model to evaluate the influence of glenoid bone loss and graft positioning on graft and cartilage contact pressures after the Latarjet procedure. Study Design: Controlled laboratory study. Methods: A finite element model of the shoulder was developed using kinematics, muscle and glenohumeral joint loading of 6 male participants. Muscle and joint forces at 90° of abduction and external rotation were calculated and employed in simulations of the native shoulder, as well as the shoulder with a Bankart lesion, 10% and 25% glenoid bone loss, and after the Latarjet procedure. Results: A Bankart lesion as well as glenoid bone loss of 10% and 25% significantly increased glenoid and humeral cartilage contact pressures compared with the native shoulder (P < .05). The Latarjet procedure did not significantly increase glenoid cartilage contact pressure. With 25% glenoid bone loss, the Latarjet procedure with a graft flush with the glenoid and the humerus positioned at the glenoid half-width resulted in significantly increased humeral cartilage contact pressure compared with that preoperatively (P = .023). Under the same condition, medializing the graft by 1 mm resulted in humeral cartilage contact pressure comparable with that preoperatively (P = .097). Graft lateralization by 1 mm resulted in significantly increased humeral cartilage contact pressure in both glenoid bone loss conditions (P < .05). Conclusion: This modeling study showed that labral damage and greater glenoid bone loss significantly increased glenoid and humeral cartilage contact pressures in the shoulder. The Latarjet procedure may mitigate this to an extent, although glenoid and humeral contact loading was sensitive to graft placement. Clinical Relevance: The Latarjet procedure with a correctly positioned graft should not lead to increased glenohumeral joint contact loading. The present study suggests that lateral graft overhang should be avoided, and in the situation of large glenoid bone defects, slight medialization (ie, 1 mm) of the graft may help to mitigate glenohumeral joint contact overloading.

What to expect after revision shoulder arthroplasty? A comprehensive review of the literature.

The number of shoulder arthroplasties has increased tremendously over the last twenty years, creating a proportional increase in complications rates and revision. Shoulder arthroplasty surgeon should have a clear understanding of the reasons for failure based on the specific index procedure that was performed. The main challenge includes the need for component removal and managing glenoid and humeral bone defects. This manuscript aims to outline the most common indications for revision surgery and treatment options based on a careful and detailed review of the available literature. This paper should help the surgeon in patient evaluation and selection of the optimal procedure for an individual patient.

Clinical Results of Knot-tying Versus Knotless Suture Anchors in Arthroscopic Anteroinferior Labral Repair.

Background Arthroscopic repair of glenohumeral instability is becoming an increasingly common procedure. These repairs can be undertaken using knot-tying and knotless suture anchors; there is currently no clear consensus in the literature about what type of repair is most cost-effective and provides superior outcomes. The purpose of this study is to examine postoperative outcomes of patients undergoing arthroscopic anteroinferior labral repair (AALR) with either knot-tying or knotless anchors. Methods A single institution retrospective observational cohort study of 122 patients undergoing AALR from January 2014 to June 2021 was conducted. Univariate statistics were used to assess differences in demographics, operative characteristics, and postoperative outcomes between repair types; multivariate analysis was used to evaluate risk factors for recurrent instability and reoperation. Results Patients undergoing AALR with knotless anchors had a shorter case duration than those with knot-tying anchors (112.64 vs. 89.86 minutes, p<0.001). There were no significant differences between groups in the size of labral tear, presence of a glenoid bone defect, or Hill-Sachs lesion. After controlling for age, BMI,sex, glenoid bone defect, number of preoperative dislocations, and fixation type, only age (OR=0.896, p=0.010) and female sex (OR=5.341, p=0.008) were independent risk factors for recurrent instability and no factors were independent predictors of reoperation. Conclusion Patients undergoing AALR experienced similar rates of reoperation and recurrent instability regardless of whether a knot-tying or knotless repair was performed. The use of knotless suture anchors may improve cost-effectiveness due to decreased surgical time without diminishing postoperative outcomes.

Outcomes of Femoral Head Allograft for the Management of Glenoid Bone Defects in Revision Reverse Shoulder Arthroplasty: A Case-Controlled Study.

Revision shoulder arthroplasty often requires management of glenoid bone defects. Options include using allograft, harvesting iliac crest autograft, or using augmented metal components. The purpose of this study is to report outcomes of revision shoulder arthroplasty requiring management of glenoid bone defects with femoral head allograft in a large cohort of patients using a single reverse shoulder implant system and compare them to a matched cohort based on the indication for surgery. Outcomes of patients who had successful glenoid reconstruction were compared to those that required a re-revision, and to a control group that was revised without the need for bone graft. This was a retrospective review of data collected from 2009 to 2018. There were 36 patients in the bone graft group and 52 in the control group. All patients underwent revision to a reverse shoulder arthroplasty to manage a failed total shoulder arthroplasty (n = 29 and 11), hemiarthroplasty (n = 1 and 24), or reverse shoulder arthroplasty (n = 6 and 17). All patients had a minimum of 2 years of clinical follow-up. The primary endpoint was survival of baseplate fixation. Secondary outcomes included range of motion and functional outcome scores. Patients that had recurrent baseplate failure and were re-revised were compared to patients with bone graft that did not require additional surgery, and to patients who were revised without the need for bone graft. Patients who required revisions for reasons other than recurrent baseplate failure were also recorded. Five of 36 (14%) patients had recurrent baseplate failure. Mean time to failure was 12 months. Three of 5 had successful re-implantation of another baseplate. Two of 5 were revised to a hemi arthroplasty after failure of their revisions. Preoperative ASES scores were 31 in the grafted patients that did not require re-revision, 39 in the grafted patients that required re-revision, and 33 in the control group. Final ASES scores were 64, 36, and 56, respectively. One patient required revision surgery not related to baseplate failure. There were no baseplate failures in the control group. The use of femoral head allograft to manage glenoid bone defects in the revision setting produces predictable improvement in functional outcomes that is not inferior to those in patients revised without bone graft. However, there is a 14% rate of baseplate failure.

Arthroscopic Subscapularis Augmentation With Xenograft Glenoid Bone Block in Patients With Recurrent Anterior Shoulder Instability

IntroductionThe purpose of this study was to investigate the clinical and radiographic outcomes at 2 years for patients who underwent an arthroscopic xenograft bone block procedure plus ASA for recurrent anteroinferior gleno-humeral instability.MethodsThis retrospective study was conducted on patients affected by chronic anteroinferior shoulder instability. The inclusion criteria were as follows: patients must be aged 18 years or older; have recurrent anteroinferior shoulder instability, a glenoid defect >10%, assessment by the Pico area measurement system, anterior capsular insufficiency, and an engaging Hill-Sachs lesion. The exclusion criteria were as follows: multidirectional instability, glenoid bone defect <10%, arthritis, and minimum follow-up less than 24 months. Clinical outcomes were evaluated according to Western Ontario Shoulder Instability Index (WOSI) and Rowe scale. Computed tomography (CT) results were evaluated to assess any signs of resorption or displacement of the xenograft at 24 months follow-up.ResultsTwenty patients that met all the inclusion criteria underwent arthroscopic xenograft bone block procedure and ASA. The mean preoperative Rowe score was 38.3 points, and it significantly improved (P < .001), increasing to 95.5 points. ROWE level at follow-up was excellent for 18 patients (90%), fair for 1 patient (5%), and poor for another patient (5%). The mean preoperative WOSI score was 1242 points, and it improved significantly (P <.0001), with a mean score of 120 points at follow-up. In all patients, the comparative study between CT scans performed postoperatively and at final follow-up did not reveal a volume reduction of the xenografts (P > .05) and absence areas affected by signs of resorption and breakage with 34.4% of postprocedural increase of the glenoid surface, were seen.ConclusionsThe combination of ASA and bone block procedure with a xenograft was effective in the glenoid reconstruction and restoration of shoulder stability. No radiographic evidence of graft resorption, graft displacement, or glenohumeral arthritis were observed at 24-month follow-up.Level of EvidenceLevel IV, therapeutic case series. The purpose of this study was to investigate the clinical and radiographic outcomes at 2 years for patients who underwent an arthroscopic xenograft bone block procedure plus ASA for recurrent anteroinferior gleno-humeral instability. This retrospective study was conducted on patients affected by chronic anteroinferior shoulder instability. The inclusion criteria were as follows: patients must be aged 18 years or older; have recurrent anteroinferior shoulder instability, a glenoid defect >10%, assessment by the Pico area measurement system, anterior capsular insufficiency, and an engaging Hill-Sachs lesion. The exclusion criteria were as follows: multidirectional instability, glenoid bone defect <10%, arthritis, and minimum follow-up less than 24 months. Clinical outcomes were evaluated according to Western Ontario Shoulder Instability Index (WOSI) and Rowe scale. Computed tomography (CT) results were evaluated to assess any signs of resorption or displacement of the xenograft at 24 months follow-up. Twenty patients that met all the inclusion criteria underwent arthroscopic xenograft bone block procedure and ASA. The mean preoperative Rowe score was 38.3 points, and it significantly improved (P < .001), increasing to 95.5 points. ROWE level at follow-up was excellent for 18 patients (90%), fair for 1 patient (5%), and poor for another patient (5%). The mean preoperative WOSI score was 1242 points, and it improved significantly (P <.0001), with a mean score of 120 points at follow-up. In all patients, the comparative study between CT scans performed postoperatively and at final follow-up did not reveal a volume reduction of the xenografts (P > .05) and absence areas affected by signs of resorption and breakage with 34.4% of postprocedural increase of the glenoid surface, were seen. The combination of ASA and bone block procedure with a xenograft was effective in the glenoid reconstruction and restoration of shoulder stability. No radiographic evidence of graft resorption, graft displacement, or glenohumeral arthritis were observed at 24-month follow-up.

Effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation for recurrent anterior shoulder dislocation with massive glenoid bone defect

To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects. Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation. All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation ( P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation ( P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months. Arthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.

Study on the evaluation of glenoid bone defects by MRI three-dimensional reconstruction

To investigate the feasibility of MRI three-dimensional (3D) reconstruction model in quantifying glenoid bone defect by comparing with CT 3D reconstruction model measurement. Forty patients with shoulder anterior dislocation who met the selection criteria between December 2021 and December 2022 were admitted as study participants. There were 34 males and 6 females with an average age of 24.8 years (range, 19-32 years). The injury caused by sports injury in 29 cases and collision injury in 6 cases, and 5 cases had no obvious inducement. The time from injury to admission ranged from 4 to 72 months (mean, 28.5 months). CT and MRI were performed on the patients' shoulder joints, and a semi-automatic segmentation of the images was done with 3D slicer software to construct a glenoid model. The length of the glenoid bone defect was measured on the models by 2 physicians. The intra-group correlation coefficient ( ICC) was used to evaluate the consistency between the 2 physicians, and Bland-Altman plots were constructed to evaluate the consistency between the 2 methods. The length of the glenoid bone defects measured on MRI 3D reconstruction model was (3.83±1.36) mm/4.00 (0.58, 6.13) mm for physician 1 and (3.91±1.20) mm/3.86 (1.39, 5.96) mm for physician 2. The length of the glenoid bone defects measured on CT 3D reconstruction model was (3.81±1.38) mm/3.80 (0.60, 6.02) mm for physician 1 and (3.99±1.19) mm/4.00 (1.68, 6.38) mm for physician 2. ICC and Bland-Altman plot analysis showed good consistency. The ICC between the 2 physicians based on MRI and CT 3D reconstruction model measurements were 0.73 [95% CI (0.54, 0.85)] and 0.80 [95% CI (0.65, 0.89)], respectively. The 95% CI of the difference between the two measurements of physicians 1 and 2 were (-0.46, 0.49) and (-0.68, 0.53), respectively. The measurement of glenoid bone defect based on MRI 3D reconstruction model is consistent with that based on CT 3D reconstruction model. MRI can be used instead of CT to measure glenoid bone defects in clinic, and the soft tissue of shoulder joint can be observed comprehensively while reducing radiation.

The prevalence of shoulders with a large glenoid defect and small bone fragment increases after several instability events during conservative treatment for traumatic anterior instability

Unstable shoulders with a large glenoid defect and small bone fragment are at higher risk for postoperative recurrence after arthroscopic Bankart repair. The purpose of the present study was to clarify the changes in the prevalence of such shoulders during conservative treatment for traumatic anterior instability. We retrospectively investigated 114 shoulders that underwent conservative treatment and computed tomography (CT) examination at least twice after an instability event in the period from July 2004 to December 2021. We investigated the changes in glenoid rim morphology, glenoid defect size, and bone fragment size from the first to the final CT. At first CT, 51 shoulders showed no glenoid bone defect, 12 showed glenoid erosion, and 51 showed a glenoid bone fragment [33 small bone fragment (<7.5%) and 18 large bone fragment (≥7.5%); mean size: 4.9±4.2% (0-17.9%)]. Among patients with glenoid defect (fragment and erosion), the mean glenoid defect was 5.4±6.6% (0-26.6%); 49 were considered a small glenoid defect (<13.5%) and 14 were a large glenoid defect (≥13.5%). While all 14 shoulders with large glenoid defect had a bone fragment, small fragment was solely seen in 4 shoulders. At final CT, 23 of the 51 shoulders persisted without glenoid defect. The number of shoulders presenting glenoid erosion increased from 12 to 24, and the number of shoulders with bone fragment increased from 51 to 67 [36 small bone fragment and 31 large bone fragment; mean size: 5.1±4.9% (0-21.1%)]. The prevalence of shoulders with no or a small bone fragment did not increase from first CT (71.4%) to final CT (65.9%; P=.488), and the bone fragment size did not decrease (P=.753). The number of shoulders with glenoid defect increased from 63 to 91 and the mean glenoid defect significantly increased to 9.9±6.6% (0-28.4%) (P<.001). The number of shoulders with large glenoid defect increased from 14 to 42 (P<.001). Of these 42 shoulders, 19 had no or a small bone fragment. Accordingly, among a total of 114 shoulders, the increase from first to final CT in the prevalence of a large glenoid defect accompanied by no or a small bone fragment was significant [4shoulders (3.5%) vs. 19 shoulders (16.7%); P=.002]. The prevalence of shoulders with a large glenoid defect and small bone fragment increases significantly after several instability events.

Predictors of Bone Loss in Anterior Glenohumeral Instability

Background: Anterior shoulder instability can result in bone loss of both the anterior glenoid and the posterior humerus. Bone loss has been shown to lead to increased failure postoperatively and may necessitate more complex surgical procedures, resulting in worse clinical outcomes and posttraumatic arthritis. Hypothesis/Purpose: The purpose of this study was to investigate predictors of glenoid and humeral head bone loss in patients undergoing surgery for anterior shoulder instability. It was hypothesized that male sex, contact sport participation, traumatic dislocation, and higher number of instability events would be associated with greater bone loss. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 892 patients with anterior shoulder instability were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. The presence and amount of anterior glenoid bone loss and accompanying Hill-Sachs lesions were quantified. Descriptive information and injury history were used to construct proportional odds models for the presence of any bone defect, for defects >10% of the anterior glenoid or humeral head, and for combined bony defects. Results: Anterior glenoid bone loss and Hill-Sachs lesions were present in 185 (20.7%) and 470 (52.7%) patients, respectively. Having an increased number of dislocations was associated with bone loss in all models. Increasing age, male sex, and non-White race were associated with anterior glenoid bone defects and Hill-Sachs lesions. Contact sport participation was associated with anterior glenoid bone loss, and Shoulder Actitvity Scale with glenoid bone loss >10%. A positive apprehension test was associated with Hill-Sachs lesions. Combined lesions were present in 19.4% of patients, and for every additional shoulder dislocation, the odds of having a combined lesion was 95% higher. Conclusion: An increasing number of preoperative shoulder dislocations is the factor most strongly associated with glenoid bone loss, Hill-Sachs lesions, and combined lesions. Early surgical stabilization before recurrence of instability may be the most effective method for preventing progression to clinically significant bone loss. Patients should be made aware of the expected course of shoulder instability, especially in athletes at high risk for recurrence and osseous defects, which may complicate care and worsen outcomes. Registration: NCT02075775 (ClinicalTrials.gov identifier).

Arthroscopic Autologous Iliac Crest Grafting Results in Similar Outcomes and Low Recurrence Compared to Remplissage Plus Bankart Repair for Anterior Shoulder Instability With Bipolar Bone Defects

To compare the functional outcomes, range of motion (ROM), recurrence rates, and complication rates of arthroscopic autologous iliac crest grafting (AICG) and Remplissage plus Bankart repair (RB) for anterior shoulder instability with bipolar bone defects. This study enrolled patients undergoing arthroscopic AICG or RB with 13.5-25% glenoid bone defect combined with Hill-Sachs lesion between January 2013 and April 2020, who had a minimum 2-year follow-up. Patient-reported outcomes were evaluated by Subjective Shoulder Value (SSV), Oxford Shoulder Instability Score (OSIS), Rowe score, Constant score, and visual analog scale (VAS) for pain. Active ROM, return to sports, recurrence, self-reported apprehension, and complications were recorded. This study included 60 patients, including 28 AICG (Group A) and 32 RB (Group R). Mean glenoid bone defect was similar (17.7% ± 3.1% vs 16.6% ± 2.4%; P= .122). Both groups showed significant postoperative improvement in Rowe score, SSV, OSIS, and Constant score. No significant difference was found in postoperative Rowe Score (87.7 vs 85.2; P= .198). A total of 20/28 (71.4%) patients in Group A versus 26/32 (81.3%) patients in Group R met the Patient Acceptable Symptomatic State determined by VAS pain score (P= .370). Both groups showed high return-to-sports rates (67.8% vs 71.8%; P= .735) and slightly decreased ROM. There were two cases of recurrence in Group A versus one in Group R (P= .594). Group R had insignificantly higher positive self-reported apprehension rate (40.6% vs 17.9%; P= .055). For anterior shoulder instability with bipolar bone defects, both arthroscopic AICG and RB can result in satisfactory clinical outcomes, good postoperative ROM, and low recurrence and complication rates. Level III, retrospective cohort study.

Bony glenoid reconstruction in revision arthroplasty

Glenoid pathologies are one of the main indications for shoulder arthroplasty revisions. In most cases, the glenoid bone defect is associated with insufficiency of the rotator cuff, so that only reverse total shoulder arthroplasty can be considered as arevision implant. For stable permanent fixation of the reverse glenoid component, to avoid inferior glenoid notching, and to achieve optimal function, physiological restoration of three-dimensional glenoid anatomy is necessary. In order to approach the individual glenoid pathologies in adifferentiated and optimal manner, it is important to classify the defects. Abasic distinction must be made between centric contained and eccentric uncontained defects. Combinations often occur. It is also important to consider the severity, depth, and three-dimensional orientation of the defect. Therefore, aCT analysis of the glenoid is essential preoperatively. The data obtained should serve as the basis for computer-assisted planning to determine the optimal position of the glenoid baseplate and the type and shape of the bone graft for the reconstruction. For patients with good bone quality, we recommend defect reconstruction with autologous iliac crest. The type of graft configuration and fixation and the decision between aone- and two-stage procedure depend on the type and severity of the defect. With technically correct reconstruction and proper prosthesis implantation, sufficient integration of the bone graft and durable fixation of the glenoid component can be expected with satisfactory clinical results. After bony reconstruction of the defects, repeated treatment with areverse arthroplasty is possible in the long term in the event of renewed glenoid problems.

Glenoid reconstruction bone loss with a pediculated coracoid autograft during shoulder arthroplasty. A technical note

Reconstruction of glenoid bone loss is a difficult but often required component of shoulder arthroplasty. A variety of free autografts or allografts have been proposed for reconstruction. While Latarjet is well accepted for the management of anterior instability, the use of a coracoid graft has not been described in conjunction with shoulder arthroplasty. We propose that anterior and central glenoid bone defects can be reconstructed with the coracoid process. to provide a vascularized local structural autograft. Level of evidence: IV.