Bony Reconstruction of the Anterior Glenoid Rim

Laurent B. Willemot, MD; Bassem T. Elhassan, MD; Olivier Verborgt, MD, PhD

Disclosures

J Am Acad Orthop Surg. 2018;26(10):e207-e218. 

In This Article

Abstract and Introduction

Abstract

Recurrent anterior shoulder instability is associated with glenohumeral bone loss. Glenoid deficiency compromises the concavity-compression mechanism. Medial Hill-Sachs lesions can result in an off-track humeral position. Anterior glenoid reconstruction or augmentation prevents recurrence by addressing the pathomechanics. In Bristow and Latarjet procedures, the coracoid process is harvested for conjoint tendon transfer, capsular reinforcement, and glenoid rim restoration. Complications and the nonanatomic nature of the procedure have spurred research on graft sources. The iliac crest is preferred for autogenous structural grafts. Tricortical, bicortical, and J-bone grafts have shown promising results despite the historical association of Eden-Hybinette procedures with early degenerative joint disease. Allogeneic osteochondral grafts may minimize the risk of arthropathy and donor site morbidity. Tibial plafond and glenoid allografts more closely match the native glenoid geometry and restore the articular chondral environment, compared with conventional grafts. Graft availability, cost, risk of disease transmission, and low chondrocyte viability have slowed the acceptance of osteochondral allografts.

Introduction

Recurrent glenohumeral instability is associated with a soft-tissue injury to the anterior capsulolabral complex, known as a Bankart lesion. However, analysis of failed capsulolabral repair procedures has demonstrated the important role of bone lesions.[1,2] Glenoid bone defects, termed bony Bankart lesions, are seen in 20% of first-time dislocations and up to 90% of recurrent dislocations.[3] Humeral bone defects, known as Hill-Sachs lesions, are found in 67% of first-time dislocations and up to 100% of recurrent dislocations.[4–6] The literature is scarce regarding the incidence of bipolar lesions, involving both the humeral and glenoid sides, with reported incidences varying between 67% and 87%.[5,6] Glenohumeral bone loss disturbs the fragile equilibrium between mobility and stability by altering the joint's congruency and constraint. It is important to address bone lesions to prevent chronic instability and the onset of early osteoarthritis. These insights have led to a surge of interest in procedures aimed at restoring shoulder stability by reconstructing, restoring, or augmenting anterior glenoid bone stock.

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