Bone loss in anterior instability

Area of Science:

• Orthopedic surgery
• Sports medicine
• Shoulder biomechanics

Background:

• Anterior shoulder instability frequently presents with associated bone loss.
• The Latarjet procedure is indicated for glenoid bone defects exceeding 25% or high-risk instability.
• Hill-Sachs lesions are common in anterior instability and require careful assessment.

Purpose of the Study:

• To review the assessment and management of bone loss in anterior shoulder instability.
• To highlight the utility of the glenoid track concept for evaluating bipolar bone lesions.
• To discuss treatment considerations for engaging Hill-Sachs lesions, particularly in overhead athletes.

Main Methods:

• Literature review focusing on Latarjet procedure, glenoid defects, Hill-Sachs lesions, and the glenoid track concept.
• Analysis of diagnostic criteria for engaging Hill-Sachs lesions.
• Discussion of surgical options including remplissage and its implications.

Main Results:

• The Latarjet procedure is a standard treatment for significant glenoid bone loss.
• The glenoid track concept aids in identifying engaging Hill-Sachs lesions.
• Engaging Hill-Sachs lesions may require specific management strategies.

Conclusions:

• Accurate assessment of bone loss and lesion characteristics is crucial for managing anterior shoulder instability.
• The glenoid track concept provides a framework for understanding bipolar bone lesions.
• Remplissage is a potential treatment for engaging Hill-Sachs lesions but may limit range of motion, necessitating careful consideration in overhead athletes.