Clin Orthop Surg.  2015 Dec;7(4):425-429. 10.4055/cios.2015.7.4.425.

Osseous Defects Seen in Patients with Anterior Shoulder Instability

• Yamamoto N
• Itoi E

• KMID: 2360254
• DOI: http://doi.org/10.4055/cios.2015.7.4.425

Abstract

Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough.

Keyword

Shoulder; Biomechanics; Bony defect

MeSH Terms

Biomechanical Phenomena
*Glenoid Cavity/injuries/pathology/physiopathology
Humans
*Humeral Head/injuries/pathology/physiopathology
Shoulder Dislocation/physiopathology
*Shoulder Joint/injuries/pathology/physiopathology

Figure

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  Fig. 1 Glenoid track. The glenoid track is defined as a zone of contact of the glenoid on the humeral head.

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  Fig. 2 The critical size of a glenoid osseous defect. The critical size of an anterior glenoid defect was biomechanically demonstrated to be the one with a width that was at least 25% of the glenoid width.

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  Fig. 3 (A) Photograph of non-engagement in the cadaveric shoulder. This Hill-Sachs lesion (arrow) is small and is located within the contact area between the glenoid and humeral head. (B) Photograph of engagement. Even though the Hill-Sachs lesion is small, engagement occurs in case with a large glenoid defect (arrow).

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  Fig. 4 Glenoid track in a case with glenoid defect. In a case with glenoid defect, the width of the true glenoid track (black line) is decreased. The defect width should be subtracted from the glenoid width.

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