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Review
. 2023 Aug;15(4):521-533.
doi: 10.4055/cios23018. Epub 2023 Jul 13.

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

Mohamad Y Fares  1 , Peter Boufadel  1 , Mohammad Daher  1 , Jonathan Koa  1 , Akshay Khanna  2 , Joseph A Abboud  1
Affiliations
Review

Anterior Shoulder Instability and Open Procedures: History, Indications, and Clinical Outcomes

Mohamad Y Fares et al. Clin Orthop Surg. 2023 Aug.

Abstract

The shoulder, being the most mobile joint in the human body, is often susceptible to dislocations and subluxations more so than other joints. As such, shoulder instability constitutes a common complaint among patients worldwide, especially those who are young, participate in contact sports, and have increased innate flexibility in their joints. Management options in the setting of instability vary between conservative and surgical options that aim to mitigate symptoms and allow return of function. Surgical options can be arthroscopic and open, with a general shift among surgeons towards utilizing arthroscopic surgery in the past several decades. Nevertheless, open procedures still play a role in managing shoulder instability patients, especially those with significant bone loss, recurrent instability, coexisting shoulder pathologies, and high risk of failure with arthroscopic surgery. In these clinical settings, open procedures, like the Latarjet procedure, open Bankart repair, glenoid bone augmentation using iliac crest autograft or distal tibial allograft, and salvage options like glenohumeral arthrodesis and arthroplasty may show good clinical outcomes and low recurrence rates. Each of these open procedures possesses its own set of advantages and disadvantages and entails a specific set of indications based on published literature. It is important to cater treatment options to the individual patient in order to optimize outcomes and reduce the risk of complications. Future research on open shoulder stabilization procedures should focus on the long-term outcomes of recently utilized procedures, investigate different graft options for procedures involving bone augmentation, and conduct additional comparative analyses in order to establish concrete surgical management guidelines.

Keywords: Bankart lesions; Contact athlete; Glenoid bone loss; Labrum; Latarjet.

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Conflict of interest statement

CONFLICT OF INTEREST: JAA would like to disclose royalties from DJO Global, Zimmer-Biomet, Smith and Nephew, Stryker, Globus Medical, INC.; research support as a PI from Lima Corporation-Italy, Orthofix, Arthrex, OREF; royalties, financial or material support from Wolters Kluwer; and Board Member/Committee appointments for American Shoulder and Elbow Society, Pacira.

Figures

Fig. 1
Fig. 1. Timeline of open procedures for shoulder stabilization procedures.
Fig. 2
Fig. 2. The Latarjet procedure involves releasing and transferring the coracoid and conjoint tendon (A) and attaching it to the anterior glenoid using one or two screws to augment the anterior glenoid defect (B).
Fig. 3
Fig. 3. Schematic representation of the J-bone graft procedure for shoulder stabilization.
See this image and copyright information in PMC

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