Glenohumeral Bone Defects: A Review of the Diagnostic and Therapeutic Advances Over the Last 20 Years
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Published:
Aug 31, 2022
Keywords:
Glenohumeral bone defects, shoulder instability, glenoid track, Hill-Sachs lesions
Main Article Content
Abstract
Introduction: The approach and treatment of glenohumeral bone defects have evolved intending to provide more individualized management for patients. However, to date, there are no articles that compile these historical advances.
Objective: To describe the most relevant literature on the diagnostic analysis and therapeutic options for glenohumeral bone defects reported in the last 20 years.
Materials and Methods: A search was conducted in the PubMed database with the terms “Glenoid defect”, “Humeral defect”, “Shoulder instability” and “Glenoid track”, filtered by year from 2000 to 2021. Studies published in English and Spanish, involving adult patients, were included.
Results: We reviewed a total of 56 articles. A narrative chronological review of the approach to glenohumeralbone defects in anterior instability was performed.
Conclusions: Technological advances have allowed the development of evaluation and management algorithms aimed at achieving the best outcomes according to the characteristics of each patient. To date, the current literature recommends surgical treatment of instability based on the objective measurement of glenohumeral bone defects, for which arthroscopy and 3D reconstruction tomography offer the most accurate quantification.
Objective: To describe the most relevant literature on the diagnostic analysis and therapeutic options for glenohumeral bone defects reported in the last 20 years.
Materials and Methods: A search was conducted in the PubMed database with the terms “Glenoid defect”, “Humeral defect”, “Shoulder instability” and “Glenoid track”, filtered by year from 2000 to 2021. Studies published in English and Spanish, involving adult patients, were included.
Results: We reviewed a total of 56 articles. A narrative chronological review of the approach to glenohumeralbone defects in anterior instability was performed.
Conclusions: Technological advances have allowed the development of evaluation and management algorithms aimed at achieving the best outcomes according to the characteristics of each patient. To date, the current literature recommends surgical treatment of instability based on the objective measurement of glenohumeral bone defects, for which arthroscopy and 3D reconstruction tomography offer the most accurate quantification.
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How to Cite
Mejía-Grueso, A., Gutiérrez-Zúñiga, D., Visbal-Otero, N., & Valbuena-Bernal, F. (2022). Glenohumeral Bone Defects: A Review of the Diagnostic and Therapeutic Advances Over the Last 20 Years. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(4), 570-578. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1518
Section
Review article
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References
1. d’Elia G, Di Giacomo A, D’Alessandro P, Cirillo LC. Traumatic anterior glenohumeral instability: quantification of
glenoid bone loss by spiral CT. Radiol Med 2008;113(4):456-503. https://doi.org/10.1007/s11547-008-0274-5
2. Markatos K, Tzivra A, Tsoutsos S, Tsourouflis G, Karamanou M, Androutsos G. Ambroise Paré (1510-1590) and
his innovative work on the treatment of war injuries. Surg Innov 2018;25(2):183-6. https://doi.org/10.1177/1553350617744901
3. Itoi E, Yamamoto N, Kurokawa D, Sano H. Bone loss in anterior instability. Curr Rev Musculoskelet Med
2013;6(1):88-94. https://doi.org/10.1007/s12178-012-9154-7
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(7):677-94. https://doi.org/10.1053/jars.2000.17715
5. Latarjet M. A propos du traitement des luxations récidivantes de l’épaule, Lyon Chit 1954;49:994-1003.
6. Burkhart SS, De Beer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder
instability. Arthroscopy 2002;18(5):488-91. https://doi.org/10.1053/jars.2002.32212
7. Porcellini G, Campi F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 2002;18(7):764-9. https://doi.org/10.1053/jars.2002.35266
8. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: an indicator of significant glenoid bone loss.
Arthroscopy 2004;20(2):169-74. https://doi.org/10.1016/j.arthro.2003.11.036
9. Caspari RB, Savoie FH. Arthroscopic reconstruction of the shoulder: The Bankart repair. En: McGinty JB (ed).
Operative arthroscopy. New York: Raven Press; 1991:507-15.
10. Morgan CD, Bodenstab AB. Arthroscopic Bankart suture repair: Technique and early results. Arthroscopy
1987;3(2):111-22. https://doi.org/10.1016/s0749-8063(87)80027-0
11. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for
arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-7. https://doi.org/10.1302/0301-620X.89B11.18962
12. Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track. J Shoulder Elbow Surg 2007;16(5):649-56. https://doi.org/10.1016/j.jse.2006.12.012
13. Chuang TY, Adams CR, Burkhart SS. Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy 2008;24(4):376-82. https://doi.org/10.1016/j.arthro.2007.10.008
14. Yamamoto N, Itoi E, Abe H, Kikuchi K, Seki N, Minagawa H, et al. Effect of an anterior glenoid defect on anterior shoulder stability: A cadaveric study. Am J Sports Med 2009;37(5):949-54. https://doi.org/10.1177/0363546508330139
15. Bollier MJ, Arciero R. Management of glenoid and humeral bone loss. Sports Med Arthrosc Rev 2010;18(3):140-8. https://doi.org/10.1097/JSA.0b013e3181e88ef9
16. Piasecki DP, Verma NN, Romeo AA, Levine WN, Bach BR Jr., Provencher MT. Glenoid bone deficiency in
recurrent anterior shoulder instability: Diagnosis and management. J Am Acad Orthop Surg 2009;17(8):482-93.
https://doi.org/10.5435/00124635-200908000-00002
17. Bhatia S, Ghodadra NS, Romeo AA, Bach BR, Verma NN, Vo ST, Provencher MT. The importance of the
recognition and treatment of glenoid bone loss in an athletic population. Sports Health 2011;3(5):435-40.
https://doi.org/10.1177/1941738111414126
18. Giles JW, Elkinson I, Ferreira LM, Faber KJ, Boons H, Litchfield R, et al. Moderate to large engaging Hill-Sachs
defects: An in vitro biomechanical comparison of the remplissage procedure, allograft humeral head reconstruction, and partial resurfacing arthroplasty. J Shoulder Elbow Surg 2012;21(9):1142-51.
https://doi.org/10.1016/j.jse.2011.07.017
19. Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al. The Hill-Sachs lesion:
diagnosis, classification, and management. J Am Acad Orthop Surg 2012;20(4):242-52. https://doi.org/10.5435/JAAOS-20-04-242
20. Kurokawa D, Yamamoto N, Nagamoto H, Omori Y, Tanaka M, Sano H, et al. The prevalence of a large Hill-Sachs lesion that needs to be treated. J Shoulder Elbow Surg 2013;22(9):1285-9. https://doi.org/10.1016/j.jse.2012.12.033
21. Metzger PD, Barlow B, Leonardelli D, Peace W, Solomon DJ, Provencher MT. Clinical application of the “glenoid
track” concept for defining humeral head engagement in anterior shoulder instability: A preliminary report. Orthop J Sports Med 2013;1(2):1-7. https://doi.org/10.1177/2325967113496213
22. Bishop JY, Jones GL, Rerko MA, Donaldson C. 3-D CT is the most reliable imaging modality when quantifying
glenoid bone loss. Clin Orthop Relat Res 2013;471(4):1251-6. https://doi.org/10.1007/s11999-012-2607-x
23. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From
“engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-8.
https://doi.org/10.1016/j.arthro.2013.10.004
24. Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, et al. Redefining “critical” bone loss in shoulder
instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med 2015;43(7):1719-25.
https://doi.org/10.1177/0363546515578250
25. Yamamoto N, Kawakami J, Hatta T, Itoi E. Effect of subcritical glenoid bone loss on activities of daily living in
patients with anterior shoulder instability. Orthop Traumatol Surg Res 2019;105(8):1467-70.
https://doi.org/10.1016/j.otsr.2019.08.015
26. McNeil JW, Beaulieu-Jones BR, Bernhardson AS, LeClere LE, Dewing CB, Lynch JR, et al. Classification and
analysis of attritional glenoid bone loss in recurrent anterior shoulder instability. Am J Sports Med 2016;45(4):767-74. https://doi.org/10.1177/0363546516677736
27. Wolke J, Herrmann DA, Krannich A, Scheibel M. Influence of bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. Am J Sports Med 2016;44(5):1131-6. https://doi.org/10.1177/0363546515626541
28. Dickens JF, Slaven SE, Cameron KL, Pickett AM, Posner M, Campbell SE, et al. Prospective evaluation of glenoid
bone loss after first-time and recurrent anterior glenohumeral instability events. Am J Sports Med 2019;47(5):1082-9. https://doi.org/10.1177/0363546519831286
29. Moroder P, Plachel F, Huettner A, Ernstbrunner L, Minkus M, Boehm E, et al. The effect of scapula tilt and best-fit circle placement when measuring glenoid bone loss in shoulder instability patients. Arthroscopy 2017;34(2):398-404. https://doi.org/10.1016/j.arthro.2017.08.234
30. Funakoshi T, Hartzler RU, Stewien E, Burkhart SS. Hill-Sachs lesion classification by the glenoid track paradigm
in shoulder instability: Poor agreement between 3-dimensional computed tomographic and arthroscopic methods. Arthroscopy 2019;35(6):1743-9. https://doi.org/10.1016/j.arthro.2018.12.005
31. Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, et al. Management of recurrent
anterior shoulder instability with bipolar bone loss: A systematic review to assess critical bone loss amounts. Am J Sports Med 2019;47(10):2484-93. https://doi.org/10.1177/0363546518791555
32. Yamamoto N, Shinagawa K, Hatta T, Itoi E. Peripheral-track and central-track Hill-Sachs lesions: A new concept of assessing an on-track lesion. Am J Sports Med 2019;48(1):33-8. https://doi.org/10.1177/0363546519886319
33. Di Giacomo G, Peebles LA, Pugliese M, Dekker TJ, Golijanin P, Sanchez A, et al. Glenoid track instability
management score: Radiographic modification of the Instability Severity Index Score. Arthroscopy 2020;36(1):56-
67. https://doi.org/10.1016/j.arthro.2019.07.020
34. Rossi LA, Frank RM, Wilke D, Provenchet M, Millet PJ, Chahla J. Bone loss in the setting of glenohumeral
instability: An Expert Consensus Statement using the Modified Delphi Technique. Arthroscopy 2020;13:S0749-
8063(21)00011-6. https://doi.org/10.1016/j.arthro.2020.12.237
glenoid bone loss by spiral CT. Radiol Med 2008;113(4):456-503. https://doi.org/10.1007/s11547-008-0274-5
2. Markatos K, Tzivra A, Tsoutsos S, Tsourouflis G, Karamanou M, Androutsos G. Ambroise Paré (1510-1590) and
his innovative work on the treatment of war injuries. Surg Innov 2018;25(2):183-6. https://doi.org/10.1177/1553350617744901
3. Itoi E, Yamamoto N, Kurokawa D, Sano H. Bone loss in anterior instability. Curr Rev Musculoskelet Med
2013;6(1):88-94. https://doi.org/10.1007/s12178-012-9154-7
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(7):677-94. https://doi.org/10.1053/jars.2000.17715
5. Latarjet M. A propos du traitement des luxations récidivantes de l’épaule, Lyon Chit 1954;49:994-1003.
6. Burkhart SS, De Beer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder
instability. Arthroscopy 2002;18(5):488-91. https://doi.org/10.1053/jars.2002.32212
7. Porcellini G, Campi F, Paladini P. Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 2002;18(7):764-9. https://doi.org/10.1053/jars.2002.35266
8. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: an indicator of significant glenoid bone loss.
Arthroscopy 2004;20(2):169-74. https://doi.org/10.1016/j.arthro.2003.11.036
9. Caspari RB, Savoie FH. Arthroscopic reconstruction of the shoulder: The Bankart repair. En: McGinty JB (ed).
Operative arthroscopy. New York: Raven Press; 1991:507-15.
10. Morgan CD, Bodenstab AB. Arthroscopic Bankart suture repair: Technique and early results. Arthroscopy
1987;3(2):111-22. https://doi.org/10.1016/s0749-8063(87)80027-0
11. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for
arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007;89(11):1470-7. https://doi.org/10.1302/0301-620X.89B11.18962
12. Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y, et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track. J Shoulder Elbow Surg 2007;16(5):649-56. https://doi.org/10.1016/j.jse.2006.12.012
13. Chuang TY, Adams CR, Burkhart SS. Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy 2008;24(4):376-82. https://doi.org/10.1016/j.arthro.2007.10.008
14. Yamamoto N, Itoi E, Abe H, Kikuchi K, Seki N, Minagawa H, et al. Effect of an anterior glenoid defect on anterior shoulder stability: A cadaveric study. Am J Sports Med 2009;37(5):949-54. https://doi.org/10.1177/0363546508330139
15. Bollier MJ, Arciero R. Management of glenoid and humeral bone loss. Sports Med Arthrosc Rev 2010;18(3):140-8. https://doi.org/10.1097/JSA.0b013e3181e88ef9
16. Piasecki DP, Verma NN, Romeo AA, Levine WN, Bach BR Jr., Provencher MT. Glenoid bone deficiency in
recurrent anterior shoulder instability: Diagnosis and management. J Am Acad Orthop Surg 2009;17(8):482-93.
https://doi.org/10.5435/00124635-200908000-00002
17. Bhatia S, Ghodadra NS, Romeo AA, Bach BR, Verma NN, Vo ST, Provencher MT. The importance of the
recognition and treatment of glenoid bone loss in an athletic population. Sports Health 2011;3(5):435-40.
https://doi.org/10.1177/1941738111414126
18. Giles JW, Elkinson I, Ferreira LM, Faber KJ, Boons H, Litchfield R, et al. Moderate to large engaging Hill-Sachs
defects: An in vitro biomechanical comparison of the remplissage procedure, allograft humeral head reconstruction, and partial resurfacing arthroplasty. J Shoulder Elbow Surg 2012;21(9):1142-51.
https://doi.org/10.1016/j.jse.2011.07.017
19. Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A, et al. The Hill-Sachs lesion:
diagnosis, classification, and management. J Am Acad Orthop Surg 2012;20(4):242-52. https://doi.org/10.5435/JAAOS-20-04-242
20. Kurokawa D, Yamamoto N, Nagamoto H, Omori Y, Tanaka M, Sano H, et al. The prevalence of a large Hill-Sachs lesion that needs to be treated. J Shoulder Elbow Surg 2013;22(9):1285-9. https://doi.org/10.1016/j.jse.2012.12.033
21. Metzger PD, Barlow B, Leonardelli D, Peace W, Solomon DJ, Provencher MT. Clinical application of the “glenoid
track” concept for defining humeral head engagement in anterior shoulder instability: A preliminary report. Orthop J Sports Med 2013;1(2):1-7. https://doi.org/10.1177/2325967113496213
22. Bishop JY, Jones GL, Rerko MA, Donaldson C. 3-D CT is the most reliable imaging modality when quantifying
glenoid bone loss. Clin Orthop Relat Res 2013;471(4):1251-6. https://doi.org/10.1007/s11999-012-2607-x
23. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From
“engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 2014;30(1):90-8.
https://doi.org/10.1016/j.arthro.2013.10.004
24. Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH, et al. Redefining “critical” bone loss in shoulder
instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med 2015;43(7):1719-25.
https://doi.org/10.1177/0363546515578250
25. Yamamoto N, Kawakami J, Hatta T, Itoi E. Effect of subcritical glenoid bone loss on activities of daily living in
patients with anterior shoulder instability. Orthop Traumatol Surg Res 2019;105(8):1467-70.
https://doi.org/10.1016/j.otsr.2019.08.015
26. McNeil JW, Beaulieu-Jones BR, Bernhardson AS, LeClere LE, Dewing CB, Lynch JR, et al. Classification and
analysis of attritional glenoid bone loss in recurrent anterior shoulder instability. Am J Sports Med 2016;45(4):767-74. https://doi.org/10.1177/0363546516677736
27. Wolke J, Herrmann DA, Krannich A, Scheibel M. Influence of bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. Am J Sports Med 2016;44(5):1131-6. https://doi.org/10.1177/0363546515626541
28. Dickens JF, Slaven SE, Cameron KL, Pickett AM, Posner M, Campbell SE, et al. Prospective evaluation of glenoid
bone loss after first-time and recurrent anterior glenohumeral instability events. Am J Sports Med 2019;47(5):1082-9. https://doi.org/10.1177/0363546519831286
29. Moroder P, Plachel F, Huettner A, Ernstbrunner L, Minkus M, Boehm E, et al. The effect of scapula tilt and best-fit circle placement when measuring glenoid bone loss in shoulder instability patients. Arthroscopy 2017;34(2):398-404. https://doi.org/10.1016/j.arthro.2017.08.234
30. Funakoshi T, Hartzler RU, Stewien E, Burkhart SS. Hill-Sachs lesion classification by the glenoid track paradigm
in shoulder instability: Poor agreement between 3-dimensional computed tomographic and arthroscopic methods. Arthroscopy 2019;35(6):1743-9. https://doi.org/10.1016/j.arthro.2018.12.005
31. Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, et al. Management of recurrent
anterior shoulder instability with bipolar bone loss: A systematic review to assess critical bone loss amounts. Am J Sports Med 2019;47(10):2484-93. https://doi.org/10.1177/0363546518791555
32. Yamamoto N, Shinagawa K, Hatta T, Itoi E. Peripheral-track and central-track Hill-Sachs lesions: A new concept of assessing an on-track lesion. Am J Sports Med 2019;48(1):33-8. https://doi.org/10.1177/0363546519886319
33. Di Giacomo G, Peebles LA, Pugliese M, Dekker TJ, Golijanin P, Sanchez A, et al. Glenoid track instability
management score: Radiographic modification of the Instability Severity Index Score. Arthroscopy 2020;36(1):56-
67. https://doi.org/10.1016/j.arthro.2019.07.020
34. Rossi LA, Frank RM, Wilke D, Provenchet M, Millet PJ, Chahla J. Bone loss in the setting of glenohumeral
instability: An Expert Consensus Statement using the Modified Delphi Technique. Arthroscopy 2020;13:S0749-
8063(21)00011-6. https://doi.org/10.1016/j.arthro.2020.12.237