Bone loss in shoulder instability: putting it all together.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Radiology

Background:

• Glenohumeral bone loss is a significant factor in recurrent shoulder instability, increasing the risk of treatment failure.
• Accurate assessment of bone loss, including glenoid track (GT) and humeral defects, is crucial for managing both anterior and posterior instability.
• Current treatment algorithms lack definitive thresholds for posterior instability and long-term comparative data.

Purpose of the Study:

• To review the evaluation and management of glenohumeral bone loss in recurrent shoulder instability.
• To discuss treatment strategies for anterior and posterior bone loss, including bony augmentation and soft tissue procedures.
• To highlight the need for further research into optimal treatment protocols.

Main Methods:

• Review of clinical presentation, physical examination, and advanced imaging (CT/MRI) for diagnosing bone loss.
• Analysis of treatment options based on the magnitude and location of glenoid and humeral bone defects.
• Discussion of patient-specific risk factors influencing management decisions.

Main Results:

• Subcritical anterior bone loss may be managed with labral repair or capsular plication; severe loss requires bony augmentation.
• Humeral lesions are addressed based on engagement with the glenoid rim, potentially via soft tissue or bony procedures.
• Management thresholds for posterior instability are less defined than for anterior instability.

Conclusions:

• Comprehensive evaluation including imaging is essential for guiding treatment of glenohumeral bone loss in shoulder instability.
• Treatment selection must consider the degree of bone loss, defect location, and patient-specific factors.
• Further high-quality studies are needed to refine treatment algorithms for anterior, posterior, and bipolar glenohumeral bone loss.