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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2016; 7(6): 343-354
Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.343
Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss
Eamon Ramhamadany, Chetan S Modi
Eamon Ramhamadany, Chetan S Modi, Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, United Kingdom
Author contributions: Ramhamadany E performed the literature search, critical analysis and wrote the paper; Modi CS reviewed and edited the paper, wrote the abstract and recorded the audio core tip.
Conflict-of-interest statement: The authors declare no conflict of interest in the production of this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Chetan S Modi, MBChB, MSc, DipSEM, FRCS (Tr and Orth), Consultant Shoulder and Elbow Surgeon, Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom. chetan.modi@uhcw.nhs.uk
Telephone: +44-2476-965094
Received: October 24, 2015
Peer-review started: October 27, 2015
First decision: February 2, 2016
Revised: February 16, 2016
Accepted: April 7, 2016
Article in press: April 11, 2016
Published online: June 18, 2016
Processing time: 233 Days and 7.1 Hours
Abstract

The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures.

Keywords: Shoulder dislocation; Bone loss; Latarjet; Hill-Sachs lesion; Remplissage

Core tip: Managing recurrent anterior gleno-humeral instability with bone loss is challenging. Each case needs to be assessed on its own merits with consideration of both glenoid and humeral bone defects and their relative position to each other. Latarjet and iliac crest graft transfers are reliable for treating glenoid lesions. The treatment of humeral defects is controversial - the early results of Remplissage for small defects are promising; large defects may require bony reconstructions or partial resurfacing. The evidence remains limited when addressing bipolar lesions.