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. 2021 Dec;14(6):447-461.
doi: 10.1007/s12178-021-09727-2. Epub 2021 Dec 28.

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

Carlos Prada  1   2 , Omar A Al-Mohrej  1   3 , Ashaka Patel  4 , Breanne Flood  2 , Timothy Leroux  5 , Moin Khan  6   7   8
Affiliations

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

Carlos Prada et al. Curr Rev Musculoskelet Med. 2021 Dec.

Abstract

Purpose of review: The aim of this scoping review is to provide an overview of the literature published over the past 5 years related to the management of bone loss in anterior shoulder instability.

Recent findings: During recent years, there has been a focus on patients at high risk for failure following soft tissue anterior stabilization (Bankart repair). A growing body of evidence suggests that anterior capsulolabral repair is insufficient in the setting of subcritical glenoid bone loss with an off-track Hill Sachs lesion. In such cases, the addition of a remplissage procedure to a Bankart repair or a bone-block augmentation to the glenoid (Latarjet, for example) is often advocated to decrease the risk of recurrent instability. Recent studies have also evaluated the role of alternative bone-block procedures in comparison to the Latarjet, outcomes with arthroscopic and open techniques as well as various fixation methods and radiological outcomes (bone graft resorption, glenohumeral osteoarthritis). Advances in our understanding of subcritical glenoid bone loss and the glenoid track concept have significantly impacted clinical decision making and treatment selection. The development of arthroscopic techniques has allowed for minimally invasive and safe arthroscopic bone-block procedures as an alternative to open procedures. Further research related to free bone-block procedures will inform long-term outcomes between these procedures and the gold standard Latarjet. Additionally, high-quality evidence is lacking to identify the ideal treatment for patients with glenoid subcritical glenoid bone defect. Variability in outcome reporting suggests the need to standardize outcome measures for future instability trials.

Keywords: Critical bone loss; Glenoid bone loss; Latarjet; Shoulder instability; Subcritical bone loss.

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Conflict of interest statement

Carlos Prada declares that he has no conflict of interest.

Omar A. Al-Mohrej declares that he has no conflict of interest.

Ashaka Patel declares that she has no conflict of interest.

Breanne Flood declares that she has no conflict of interest.

Tim Leroux declares that he has no conflict of interest.

Moin Khan reports grants and personal fees from Arthrex, personal fees from bioventus, and sanofi outside the submitted work.

Figures

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Fig. 1
Number of publications per year 2016–2021
Fig. 2
Fig. 2
Distribution of included articles by study designs
Fig. 3
Fig. 3
Level of evidence by year 2016–2021
Fig. 4
Fig. 4
Distribution of included articles by publication journal type
Fig. 5
Fig. 5
Distribution of included articles by location
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