Glenoid Diameter Is an Inaccurate Method for Percent Glenoid Bone Loss Quantification: Analysis and Techniques for Improved Accuracy
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The integrity of the bony architecture of the glenoid has recently been highlighted as one of the most important factors influencing the success of treatment in patients with glenohumeral instability. After a traumatic anterior shoulder dislocation initially occurs, an associated glenoid rim fracture may compromise the fundamental static restraints of the glenohumeral joint, thereby making future shoulder instability events more likely. Loss of the glenoid’s osseous conformity significantly inhibits its ability to withstand shear stress. Over time, recurrent dislocations may further propagate attritional bone loss, leading to additional instability.
In patients with recurrent anterior shoulder instability, the principles of surgical management are guided by the extent of glenoid osseous deficiency, in addition to other factors such as humeral bone defects, surgeon experience, and patient-specific considerations such as work and athletic demands. Cadaveric studies have shown that as the amount of glenoid bone loss approaches 15% to 20% of the anterior glenoid surface, significant alterations in the biomechanical stability of the glenohumeral joint occur. For this reason, current treatment algorithms in high-demand patients with recurrent anterior shoulder instability suggest that an open procedure, such as the Latarjet procedure or bone grafting with autologous iliac crest or distal tibial allograft, should be strongly considered over a soft tissueeonly repair when quantified bone loss exceeds 20%.
The purpose of this study was to compare diameter-based glenoid bone loss quantification with a true geometric calculation for the area of a circular segment.
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