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J Am Acad Orthop Surg, Vol 17, No 8, August 2009, 482-493.
© 2009 the American Academy of Orthopaedic Surgeons
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Glenoid Bone Deficiency in Recurrent Anterior Shoulder Instability: Diagnosis and Management

Dana P. Piasecki, MD, Nikhil N. Verma, MD, Anthony A. Romeo, MD, William N. Levine, MD, Bernard R. Bach, Jr, MD and LCDR Matthew T. Provencher, MD, MC, USN

Dr. Piasecki is Attending Surgeon, OrthoCarolina Sports Medicine Center, Charlotte, NC. Dr. Verma is Attending Surgeon, Division of Sports Medicine, Department of Orthopaedics, Rush University Medical Center, Chicago, IL. Dr. Romeo is Associate Professor, Department of Orthopaedics, and Section Head, Shoulder and Elbow Surgery, Division of Sports Medicine, Rush University Medical Center. Dr. Levine is Director of Sports Medicine, Department of Orthopaedics, Columbia University, New York, NY. Dr. Bach is Director, Division of Sports Medicine, Department of Orthopaedics, Rush University Medical Center. Dr. Provencher is Director, Shoulder and Sports Surgery, Department of Orthopaedic Surgery, Naval Medical Center San Diego, San Diego, CA.

Dr. Verma or a member of his immediate family is a member of a speakers’ bureau or has made paid presentations on behalf of Smith & Nephew and Arthrosurface; serves as a paid consultant to or is an employee of Smith & Nephew; has received research or institutional support from Smith & Nephew, DJ Orthopedics, and Arthrex; and has stock or stock options held in Omeros. Dr. Romeo or a member of his immediate family has received royalties from, is a member of a speakers’ bureau or has made paid presentations on behalf of, serves as a paid consultant to or is an employee of, has received research or institutional support from, has stock or stock options held in, and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Arthrex. Dr. Levine or a member of his immediate family serves as an unpaid consultant to Acumed and Stryker; has received research or institutional support from Arthrex, Arthrotek, Smith & Nephew, Stryker, and Zimmer; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Marcel-Dekker. Dr. Bach or a member of his immediate family has received research or institutional support from Smith & Nephew, DJ Orthopedics, MioMed Orthopaedics, and Athletico. Dr. Provencher or a member of his immediate family serves as a board member, owner, officer, or committee member of American Orthopaedic Society for Sports Medicine, Society of Military Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and has received research or institutional support from Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine. Neither Dr. Piasecki nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Reprint requests: Dr. Romeo, Rush University Medical Center, Sports Medicine Department, Suite 1063, 1725 West Harrison Street, Chicago, IL 60612.

Recurrent anterior shoulder instability may result from a spectrum of overlapping, often coexistent factors, one of which is glenoid bone loss. Untreated, glenoid bone loss may lead to recurrent instability and poor patient satisfaction. Recent studies suggest that the glenoid rim is altered in up to 90% of shoulders with recurrent instability, thus underscoring the need for careful diagnosis, quantification, and preoperative evaluation. Biomechanical and clinical studies offer criteria that may be used in both primary and revision settings to judge whether shoulder stability is compromised by a bony defect. Along with patient activity level, these criteria can help guide the surgeon in selecting treatment options, which range from nonsurgical care to isolated soft-tissue repair as well as various means of bony reconstitution.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.