Managing Bone Loss in Shoulder Instability-Techniques and Outcomes: a Scoping Review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Instability Research

Background:

• Anterior shoulder instability often involves bone loss, particularly in the glenoid.
• Traditional soft tissue repairs (Bankart) may fail in cases of significant glenoid bone loss or associated Hill-Sachs lesions.
• The glenoid track concept has improved understanding of bone loss impact on instability.

Purpose of the Study:

• To review the last five years of literature on managing bone loss in anterior shoulder instability.
• To summarize current evidence on surgical techniques for glenoid bone defects.
• To identify gaps in knowledge regarding optimal treatment strategies.

Main Methods:

• Scoping review of published literature.
• Analysis of studies focusing on bone augmentation and soft tissue repair combinations.
• Evaluation of outcomes for various surgical approaches (open vs. arthroscopic) and fixation methods.

Main Results:

• Anterior capsulolabral repair alone is insufficient for subcritical glenoid bone loss with off-track Hill-Sachs lesions.
• Remplissage or bone-block augmentation (e.g., Latarjet procedure) is frequently recommended to reduce recurrent instability.
• Arthroscopic bone-block procedures are emerging as minimally invasive alternatives to open techniques.
• Further research is needed to compare long-term outcomes of different bone-grafting procedures and standardize outcome measures.

Conclusions:

• Management of anterior shoulder instability with bone loss has evolved, emphasizing bone augmentation for specific patient profiles.
• Arthroscopic techniques offer promising minimally invasive options.
• High-quality evidence is still lacking to definitively determine the ideal treatment for glenoid bone defects, necessitating standardized outcome reporting in future trials.