AANA/SOMOS Enduring Shoulder Program 2024-20 y.o. Army Cadet Wrestler with Recurrent Posterior Instability, 15% Posterior Glenoid Loss Mild Retroversion, Elevated Acromion and Neutral Posterior Acromial Tilt

20 y.o. Army Cadet Wrestler with Recurrent Posterior Instability, 15% Posterior Glenoid Loss Mild Retroversion, Elevated Acromion and Neutral Posterior Acromial Tilt

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Video Transcription

Video Summary

The session addresses the complex issue of posterior shoulder instability, particularly in athletes like wrestlers and military personnel, emphasizing the challenges of bone loss and retroversion. Dr. Abrams highlights that posterior instability differs fundamentally from anterior cases, involving subluxation rather than dislocation, with significant roles for scapular muscle control and subtle bone loss. He advocates for precise soft tissue repair techniques and cautious postoperative management. Dr. Donahue underscores the higher prevalence of posterior instability in military populations and stresses the critical impact of glenoid retroversion and bone loss on outcomes. He suggests bone augmentation should be considered at 10-15% bone loss given the high failure rates of soft tissue repair alone. Dr. Waterman presents surgical approaches to posterior glenoid augmentation, favoring distal tibial allograft, and discusses technical pearls for graft placement and fixation, cautioning against over-compression to avoid arthritis. The importance of addressing humeral head lesions is also noted. Practical surgical tips highlight the use of lateral portals, mattress sutures, and preoperative physical therapy focused on scapular control. Overall, the experts emphasize the evolving understanding of posterior instability, the need for individualized treatment considering bone loss severity, and the critical role of restoring scapular muscle function alongside surgical repair. Postoperative rehab is tailored, with push-ups typically reintroduced around five months to ensure rotator cuff strength and joint stability.

Asset Caption

Posterior Bankart Works Just Fine (Jeffrey S. Abrams, M.D.) vs. Posterior Bone Block is Essential (Michael A. Donohue, M.D.)
Discussion, moderated by Travis J. Dekker, M.D., FAANA
Technique Video: Posterior Glenoid Bone Grafting (Brian R. Waterman, M.D., FAANA)

Keywords

posterior shoulder instability

bone loss

glenoid retroversion

soft tissue repair

bone augmentation

distal tibial allograft

scapular muscle control