Editorial Commentary: For Patients With Shoulder Instability, On-Track Hill-Sachs Lesion Plus Subcritical Glenoid Bone Loss May Be the Best Indication for Dynamic Anterior Stabilization Using the Long Head of the Biceps Tendon

Abstract

As the definition of shoulder glenoid critical bone loss has evolved and decreased from 25% to 17% to 13.5%, indications for bone block procedures for shoulder instability with glenoid bone loss have expanded. While the bone block procedure is an effective treatment for almost all cases of anterior shoulder instability, regardless of the amount of bone loss, many surgeons prefer to perform a bone block procedure only in cases of critical bone loss due to risk of complications. Thus, for cases of minimal (subcritical) bone loss, Remplissage has been recommended to enhance Bankart repair. As an alternative, dynamic anterior stabilization (DAS) using the long head of the biceps tendon has been recommended as a surgical option in patients with shoulder instability and subcritical bone loss. How do we decide? A biomechanical study shows DAS is an effective method for on-track Hill-Sachs lesions with subcritical bone loss, and Remplissage is more effective for off-track Hill-Sachs lesions. Clinical studies are required to complement biomechanical findings.