Case-Based, Advanced Decision-Making in Complex Shoulder Instability: Anterior, Posterior, Bone Loss and Revisions (2025 Annual Meeting)-Case-Based, Advanced Decision-Making in Complex Shoulder Instability: Anterior, Posterior, Bone Loss and Revisions

Video Transcription

Video Summary

This interactive session focused on complex cases of anterior-posterior shoulder instability and bone loss, highlighted by presentations from experienced shoulder surgeons. The discussion began with a 24-year-old male seizure patient with recurrent anterior shoulder dislocations despite prior arthroscopic Bankart repair. Imaging revealed a large Hill-Sachs lesion and glenoid bone loss, making repeat soft-tissue repair insufficient. An open Latarjet procedure was attempted but found inadequate intraoperatively, leading to a two-stage approach with a fresh distal tibia allograft for the glenoid and humeral head osteochondral allograft for the Hill-Sachs defect. The patient had successful bone incorporation and clinical improvement, though some bone resorption was noted at follow-up.<br /><br />Next, a 16-year-old weightlifter with posterior shoulder instability and dysplastic posterior glenoid was reviewed. After failed soft-tissue repair, the panel favored a posterior distal tibia allograft. Despite good initial results, graft resorption and pain developed long-term, illustrating challenges in graft fixation, potential nerve injury, and the need for better solutions for bony posterior instability and glenoid morphology abnormalities.<br /><br />Lastly, a 31-year-old female with multiple failed anterior instability surgeries including a Latarjet and persistent pain/instability was discussed. Imaging showed significant glenoid bone loss and graft resorption. Surgical revisions included hardware removal, arthroscopic graft fixation with newer cerclage techniques, and possible infection workup for low virulence organisms like Cutibacterium acnes. The importance of addressing both bone loss and soft tissue integrity, including use of mattress sutures and remplissage procedures, was emphasized. Recent data on remplissage showed reduced failure rates with minimal loss in external rotation, relevant for throwing athletes.<br /><br />Overall, the session underscored the complexity of managing severe glenoid and humeral bone loss in unstable shoulders, the importance of individualized surgical planning, use of advanced grafting techniques, and the challenges including graft resorption, infection, and neurological injury. Ongoing research and experience sharing remain vital for improving outcomes.

Asset Caption

Richard K.N. Ryu, M.D. | Michael J. O'Brien, M.D., FAANA | Stephen A. Parada, M.D. | Jeanne C. Patzkowski, M.D., FAANA | John M. Tokish, M.D., FAANA

Keywords

anterior-posterior shoulder instability

bone loss

Hill-Sachs lesion

glenoid bone loss

arthroscopic Bankart repair

Latarjet procedure

distal tibia allograft

osteochondral allograft

posterior shoulder instability

graft resorption

remplissage procedure

Cutibacterium acnes infection