Glenoid Bone Loss – A Retrospective Evaluation of Functional Outcomes after Bone Block Surgery for Anterior Shoulder Instability in High-demand Athletes

Abstract

Objective This study assesses the relationship between the glenoid bone loss size and range of motion, functional outcomes, and complications in high-performance athletes undergoing bone block surgery for anterior shoulder instability.

Methods This retrospective study evaluated postoperative outcomes in athletes submitted to bone block surgery for anterior shoulder instability. In 5 years, 41 shoulders underwent the procedure; 20 had bone losses up to 15%, and 21 shoulders presented bone losses ranging from 15% and 25%.

Results There was no statistically significant difference regarding postoperative complications, new dislocations, and the rate of return to sports. In addition, the quantitative criteria evaluated, i.e., ranges of motion and functional scores, showed no statistically significant difference between groups.

Conclusion The size of the bone loss per se does not seem to affect functional outcomes and complications from these procedures, which are safe techniques for small and large bone losses.

Keywords

athletes - glenoid cavity - grafting, bone - joint instability - shoulder

• Referências

• 1 Schroder DT, Provencher MT, Mologne TS, Muldoon MP, Cox JS. The modified Bristow procedure for anterior shoulder instability: 26-year outcomes in Naval Academy midshipmen. Am J Sports Med 2006; 34 (05) 778-786
• 2 Di Giacomo G, Peebles LA, Pugliese M. et al. Glenoid Track Instability Management Score: Radiographic Modification of the Instability Severity Index Score. Arthroscopy 2020; 36 (01) 56-67
• 3 Dekker TJ, Peebles LA, Bernhardson AS. et al. Risk Factors for Recurrence After Arthroscopic Instability Repair-The Importance of Glenoid Bone Loss >15%, Patient Age, and Duration of Symptoms: A Matched Cohort Analysis. Am J Sports Med 2020; 48 (12) 3036-3041
• 4 Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000; 16 (07) 677-694
• 5 Ahmed I, Ashton F, Robinson CM. Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am 2012; 94 (14) 1308-1315
• 6 Shaha JS, Cook JB, Song DJ. et al. Redefining “Critical” Bone Loss in Shoulder Instability: Functional Outcomes Worsen With “Subcritical” Bone Loss. Am J Sports Med 2015; 43 (07) 1719-1725
• 7 Nakagawa S, Mae T, Yoneda K, Kinugasa K, Nakamura H. Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes. Am J Sports Med 2017; 45 (09) 1967-1974
• 8 Nakagawa S, Hirose T, Uchida R. et al. A Glenoid Defect of 13.5% or Larger Is Not Always Critical in Male Competitive Rugby and American Football Players Undergoing Arthroscopic Bony Bankart Repair: Contribution of Resultant Large Bone Fragment. Arthroscopy 2022; 38 (03) 673-681
• 9 Dickens JF, Owens BD, Cameron KL. et al. The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football. Am J Sports Med 2017; 45 (08) 1769-1775
• 10 Bonnevialle N, Mansat P, Bellumore Y, Mansat M, Bonnevialle P. [Surgical treatment of anterior shoulder instability in rugby players: clinical and radiographic results with minimum five-year follow-up]. Rev Chir Orthop Repar Appar Mot 2008; 94 (07) 635-642
• 11 Sachs RA, Lin D, Stone ML, Paxton E, Kuney M. Can the need for future surgery for acute traumatic anterior shoulder dislocation be predicted?. J Bone Joint Surg Am 2007; 89 (08) 1665-1674
• 12 Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: quantification of glenoid bone loss with CT. AJR Am J Roentgenol 2003; 180 (05) 1423-1430
• 13 Leme L. Tradução, Adaptação e Validação da Escala "Athletic Shoulder Outcome Rating Scale" para Língua Portuguesa [dissertação]. São Paulo: Universidade Federal de São Paulo, Escola Paulista de Medicina; 2005
• 14 Barbosa G, Leme L, Saccol MF, Pochini AC, Ejnisman B, Griffin S. Translation and cultural adaptation of the western ontario shoulder instability index (WOSI) for the Portuguese from Brazil. Rev Bras Med Esporte 2012; 18 (01) 35-37
• 15 Knaut LA, Moser AD, Melo SdeA, Richards RR. Translation and cultural adaptation to the portuguese language of the American Shoulder and Elbow Surgeons Standardized Shoulder assessment form (ASES) for evaluation of shoulder function. Rev Bras Reumatol 2010; 50 (02) 176-189
• 16 Jeon YS, Jeong HY, Lee DK, Rhee YG. Borderline Glenoid Bone Defect in Anterior Shoulder Instability: Latarjet Procedure Versus Bankart Repair. Am J Sports Med 2018; 46 (09) 2170-2176
• 17 Dauzère F, Faraud A, Lebon J, Faruch M, Mansat P, Bonnevialle N. Is the Latarjet procedure risky? Analysis of complications and learning curve. Knee Surg Sports Traumatol Arthrosc 2016; 24 (02) 557-563
• 18 Butt U, Charalambous CP. Complications associated with open coracoid transfer procedures for shoulder instability. J Shoulder Elbow Surg 2012; 21 (08) 1110-1119
• 19 Bohu Y, Abadie P, van Rooij F, Nover L, Berhouet J, Hardy A. Société Française de Traumatologie du Sport. Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores. Knee Surg Sports Traumatol Arthrosc 2021; 29 (08) 2606-2615