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Review
. 2023 Jun 8;8(6):468-481.
doi: 10.1530/EOR-22-0084.

Current concepts in chronic traumatic anterior shoulder instability

Stefan Bauer  1   2 , Phillipe Collin  3   4   5 , Matthias A Zumstein  6   7   8 , Lionel Neyton  9 , William G Blakeney  2   10
Affiliations
Review

Current concepts in chronic traumatic anterior shoulder instability

Stefan Bauer et al. EFORT Open Rev. .

Abstract

Chronic traumatic anterior shoulder instability can be defined as recurrent trauma-associated shoulder instability requiring the assessment of three anatomic lesions: a capsuloligamentous and/or labral lesion; anterior glenoid bone loss and a Hill-Sachs lesion. Surgical treatment is generally indicated. It remains controversial how risk factors should be evaluated to decide between a soft-tissue, free bone-block or Latarjet-type procedure. Patient risk factors for recurrence are age; hyperlaxity; competitive, contact and overhead sports. Trauma-related factors are soft tissue lesions and most importantly bone loss with implications for treatment. Different treatment options are discussed and compared for complications, return to sports parameters, short- and long-term outcomes and osteoarthritis. Arthroscopic Bankart and open Latarjet procedures have a serious learning curve. Osteoarthritis is associated with the number of previous dislocations as well as surgical techniques. Latarjet-type procedures have the lowest rate of dislocation recurrence and if performed correctly, do not seem to increase the risk of osteoarthritis.

Keywords: Bankart; Latarjet; arthroscopic stabilization; bone block; bone grafting; dislocation; instability; remplissage; shoulder.

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Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Figures

Figure 1
Figure 1
Flowchart for indications of established surgical techniques according to risk factors and patient profile.
Figure 2
Figure 2
Recurrence of any instability as published by Gerber’s group (12).
Figure 3
Figure 3
Latarjet–Patte with Walch’s technique and stabilizing mechanisms. (A) Capsular repair to CAL. (B) Bone augmentation. (C) Sling effect by the conjoint tendon. (D) Hammock effect by the lower subscapularis.
Figure 4
Figure 4
(A/B) ‘Anchor arthropathy’ (A) and arthropathy related to lateral Latarjet overhang (B).
Figure 5
Figure 5
Inversed relationship: bone loss and dislocation resistance according to Gerber & Nyffeler (35).
Figure 6
Figure 6
The glenoid-track concept.
See this image and copyright information in PMC

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