Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2015; 6(5): 421-433
Published online Jun 18, 2015. doi: 10.5312/wjo.v6.i5.421
Effect of bone loss in anterior shoulder instability
Grant H Garcia, Joseph N Liu, David M Dines, Joshua S Dines
Grant H Garcia, Joseph N Liu, David M Dines, Joshua S Dines, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: David M Dines has a patent with Biomet Inc with royalties paid. Joshua S Dines reports personal fees from Arthrex, Conmed Linvatec outside of the submitted work for consulting. Dr. Dines also receives research support from Arthrex outside of the submitted work. Joseph N Liu and Grant H Garcia have no conflicts of interest to report.
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:
Correspondence to: Grant H Garcia, MD, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.
Telephone: +1-212-6061466
Received: March 16, 2015
Peer-review started: March 21, 2015
First decision: April 10, 2015
Revised: April 20, 2015
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: June 18, 2015

Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment options and others for addressing bone loss complicating anterior glenohumeral instability.

Keywords: Latarjet, Remplissage, Glenoid deficiency, Hill-Sachs lesion, Anterior instability

Core tip: Anterior bony instability is a multifactorial problem, with osseous lesions existing on the glenoid, the humeral head or in combination. For glenoid lesions recent data has suggested Latarjet as a good option in these patients, with the potential in the near future for a technically feasible arthroscopic approach. With humeral head lesions, remplissage has demonstrated excellent short-term outcomes and offers an arthroscopic method. In the future longer-term studies will be needed for the remplissage procedure. Overall, there are many surgical options to treat these difficult patients each with their own unique aspects.