Avoidance of Arthroscopic Shoulder Instability Surgery in Cases Involving Bony Defects

Abstract

Abstract
Success rates of arthroscopic surgery for shoulder instability have improved greatly over the past decade and are now comparable to open procedures. However, significant glenoid bone deficits (greater than 25–30%) or large humeral head deficits are relative contraindications to arthroscopic stabilization. In these cases, the bony deficit must be addressed in addition to the soft tissues in order to restore stability. This review examines the various open surgical alternatives used in the presence of bony deficits of both the glenoid and humeral head. While opentechniques for addressing bony deficits are well established, they are more invasive and associated with long-term glenohumeral arthrosis and loss of motion. Clearly, bony defects associated with shoulder instability are still a major challenge within orthopaedic surgery and techniques continue to evolve. Future techniques including the arthroscopic Bristow and Latarjet procedures may allow surgeons to manage significant bone defects without the need for more invasive open exposure.

Keywords
Arthroscopic stabilization, recurrent anterior instability, bony Bankart, Hill-Sachs lesion, Bristow, Latarjet

Disclosure: The authors have no conflicts of interest to declare.
Received: August 20, 2009 Accepted: September 30, 2009
Correspondence: William N Levine, MD, 622 W, 168th Street, PH-1117, New York, NY 10032. E: wnl1@columbia.edu