Implications of Bone Loss for Surgical Management
In general, surgical management of anterior shoulder instability involves repairing injured soft-tissue structures and/or addressing glenohumeral bone loss. First-time dislocations with minimal bone loss or "on-track" lesions can typically be treated with a soft-tissue stabilization procedure (e.g., Bankart repair), which may be performed through an open or arthroscopic approach. Patients with significant bone loss or "off-track" lesions have high rates of recurrence after Bankart repair alone and often require reconstitution of the glenohumeral bony architecture. In this manner, accurate quantification of glenohumeral bone loss based on preoperative imaging is key in determining the appropriate surgical treatment of anterior shoulder instability. The amount of glenoid bone loss that necessitates reconstruction, a concept referred to as critical bone loss, remains a topic of considerable debate with recent estimates as low as 13.5%. Although glenohumeral bone loss is most often addressed through reconstruction of the glenoid surface, patients with particularly large HSLs may require reconstitution of the humeral head by filling the defect with either soft-tissue structures (e.g., Remplissage procedure) or bone graft to prevent engagement.
J Am Acad Orthop Surg. 2022;30(12):563-572. © 2022 American Academy of Orthopaedic Surgeons