Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.343
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
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.
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.