AANA25 Shoulder Access Pass-CONCURRENT SESSION 3G: Shoulder Bone Blocks

Video Transcription

Video Summary

The session on 2025 shoulder bone block concepts focused on advancing understanding of glenoid bone loss measurement, graft selection, fixation methods, and humeral bone treatment in anterior shoulder instability. Key points included the challenge of accurately measuring glenoid bone loss, with new research suggesting refined ratios and highlighting variability among surgeons. Bone graft resorption versus remodeling was discussed, emphasizing that oversized grafts tend to remodel back to normal size over years.<br /><br />Multiple graft options were reviewed: iliac crest, distal tibial allografts (DTA), distal clavicle, and scapular spine grafts, with evidence supporting comparable outcomes among some grafts, but limited clinical data for others. Fixation methods were debated extensively; traditional screw fixation offers strong compression and historical stability with low recurrence rates but carries risks of complications and hardware removal. Conversely, suture button systems and newer cerclage techniques promise less hardware-related issues and comparable biomechanical stability, though early buttons showed higher redislocation rates and resorption. The ongoing evolution towards arthroscopic, screwless fixation was highlighted for being safer and easier to teach remotely.<br /><br />Humeral bone loss considerations introduced refined concepts of “distance to dislocation” (DTD) and “near-track” lesions, which better predict failure risk than the classic on-track/off-track model. Remplissage use was advocated for high-risk on-track lesions, contact athletes, and critical humeral bone loss to reduce recurrence rates. A scoring system (PIT score) incorporating demographic and anatomic risk factors was proposed to guide decision-making for remplissage.<br /><br />Innovative arthroscopic techniques, such as arthroscopic anterior glenoid reconstruction (AAGR), were presented with emphasis on precise graft sizing, safe access portals, and soft tissue repair to restore shoulder stability. Discussions stressed the importance of graft position, biological healing, remodeling, and ongoing need for long-term outcome data. The debate between screw vs. button fixation underscored that both have merits, and future advances are needed to optimize biomechanical and biological integration. Ultimately, individualized treatment considering bone loss extent, graft type, fixation method, and patient factors is critical for optimal shoulder instability management in 2025.

Asset Caption

Moderator: Ivan H. Wong, M.D., FAANA
Georgios Mamarelis, M.D., FRCS, Ed(Tr & Orth) | Albert Lin, M.D. | Josef K. Eichinger, M.D., FAANA | John M. Tokish, M.D., FAANA

Keywords

shoulder bone block

glenoid bone loss

graft selection

fixation methods

humeral bone treatment

anterior shoulder instability

iliac crest graft

distal tibial allograft

suture button fixation

arthroscopic anterior glenoid reconstruction