Ian Power


Anterior shoulder instability can be problematic in the young, active population, particularly in athletes and military personnel. The shoulder joint is the most frequently dislocated joint, and there is a high rate of dislocation recurrence in younger patients. The stability of the glenohumeral joint is conferred through the bony anatomy and the static and dynamic stabilizers. Recognizing pathological features, identifying glenoid bone loss, and detecting Bankart and Hill-Sachs lesions are key to formulating an appropriate treatment strategy and improving surgical outcomes. Furthermore, the concept of critical bone loss has been refined by looking at subcritical loss. Recent evidence has shown that patients with glenoid bone loss at or above a subcritical level of 13.5% had higher re-dislocation rates, and those patients that did not re-dislocate experienced worse outcomes compared to those without subcritical bone loss. Intraoperative estimations of bone loss may not be always accurate, and advanced preoperative imaging using computed tomography or magnetic resonance imaging can be useful. To help assess successful treatment of anterior shoulder instability, I reviewed glenoid anatomy, injury workup, bone loss, the concept of glenoid track for engaging lesions, determination of bone loss, subcritical bone loss, and surgical treatment. Careful assessment of both types of lesions, the patient’s preferred activity level, and postoperative goals allows surgeons to decide between procedures to restore anterior glenoid bone deficits and soft-tissue repair and determine any role for a Remplissage procedure.

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