AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Inestabilidad de hombro y defectos óseos: El concepto del glenoid track-Mario V. Larrain, MD

Pdf Summary

This document by Dr. Mario Larrain from Buenos Aires, Argentina, provides a comprehensive overview of the treatment of shoulder instability associated with significant bone defects, focusing on traumatic glenohumeral injuries.<br /><br />Recurrent shoulder instability is common with osseous defects, occurring in 67% of 194 patients overall and up to 80% in contact sport athletes such as rugby players. Among 1205 arthroscopic cases of traumatic shoulder instability treated between 1989 and 2011, 33% presented bone defects, with glenoid bone loss exceeding 20% identified as the main cause of arthroscopic repair failure.<br /><br />The bone lesions include bony Bankart lesions with glenoid erosion, glenoid defects due to friction or erosion, and Hill-Sachs compression fractures. Defects are evaluated through radiographic methods (e.g., West Point view), 3D CT scans, and arthroscopic measurement. Glenoid bone loss of about 20% significantly reduces joint stability and increases recurrence even after Bankart repair.<br /><br />The concept of the "glenoid track" is highlighted, representing the maximal contact area between the humeral head and the glenoid during ranges of motion, serving as a guide in assessing lesion engagement and planning treatment.<br /><br />Surgical tactics involve thorough arthroscopic assessment of the bone defect, fragment characteristics, and associated soft tissue quality. Techniques for fragment repositioning include simple and double-point suture repairs, with better outcomes in acute versus chronic cases. Osteosynthesis is applied for glenoid and greater tuberosity fractures.<br /><br />For glenoid defects under 20% with a viable fragment, arthroscopic stabilization and fragment reinsertion are preferred. Larger defects or off-track lesions may require open or arthroscopic bone grafting (e.g., iliac crest or distal tibia allografts) or the modified Latarjet procedure, which transfers bone and tendon to restore stability. Other adjunct procedures include capsular plication and remplissage to address Hill-Sachs lesions.<br /><br />Outcomes show high success rates (95-97% good to excellent), low recurrence (2.7-5%), and return to sports in about 5 months. The document reinforces the importance of individualized surgical planning based on defect size, fragment viability, lesion tracking, and combined bone loss patterns to optimize shoulder stability in athletes and active patients.

Asset Caption

(Bone Mediated Shoulder Instability: The Glenoid Track Concept)

Keywords

shoulder instability

bone defects

glenohumeral injuries

recurrent shoulder dislocation

glenoid bone loss

bony Bankart lesions

Hill-Sachs fractures

glenoid track

arthroscopic repair

Latarjet procedure