[Anterior glenoid rim defects of the shoulder]

Bony instability of the shoulder due to glenoid defects has recently received increasing attention. Glenoid defects can be divided into acute fragment-type lesions (type I), chronic fragment-type lesions (type II) and glenoid bone loss without a bony fragment (type III). The diagnosis and classification are mainly based on imaging methods including a radiographic instability series and/or computed tomography. The management of anterior glenoid rim lesions depends on many factors including the clinical presentation, type of lesion, concomitant pathology as well as age and functional demands of the patient. If bony-mediated instability is present, surgery is indicated. In the majority of cases fragment-type lesions can be successfully treated using either arthroscopic or open reconstruction techniques.Small erosion-type lesions can also be managed via soft-tissue procedures, whereas large erosion-type lesions with significant bone loss may necessitate bone-grafting procedures (autologous iliac crest or coracoid transfer) to restore glenoid concavity and shoulder stability. Although glenoid bone grafting is usually performed via an open approach, recent clinical studies have shown that it can be successfully managed by advanced arthroscopic techniques.