Allograft Reconstruction for Glenoid Bone Loss in Glenohumeral Instability: A Systematic Review
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Glenoid bone loss can play a significant role in recurrent glenohumeral instability and is often identified as the source of failure after shoulder stabilization. The prevalence of anteroinferior glenoid rim deficiency in recurrent instability ranges from 5% to more than 70% of cases. The likelihood of glenoid bone loss is increased in patients with chronic recurrent instability, a high-energy mechanism of injury (i.e., in collision athletes), and a history of recurrent dislocations occurring with less force. Loss of the anteroinferior glenoid rim leads to loss of the glenoid articular arc, compromising the concavity compression mechanism and thus increasing the risk of recurrence of instability. It also reduces the articulating surface area of the glenoid, which may potentially increase contact pressures and the risk of future degenerative joint disease.
Arthroscopic Bankart repair has been associated with a recurrence rate of 4% in the absence of significant glenoid bone loss versus 67% in patients with greater than 25% loss of inferior glenoid diameter or an engaging Hill-Sachs lesion. Untreated glenoid deficiency can also limit the recovery of range of motion after Bankart repair and is a recognized cause of failed shoulder stabilization surgery.
Glenoid reconstruction is typically indicated in situations of 25% or greater bone loss, or when revision stabilization becomes necessary. The surgical management of glenoid deficiency is challenging. Both open and arthroscopic techniques have been used, and common strategies include the use of coracoid transfer and iliac crest autografts or allografts. Although these procedures have been successful in restoring glenohumeral stability, nonanatomic coracoid transfer procedures to address glenoid bone loss have been associated with progression to instability arthropathy.
The purpose of this study by Dr. Verma and his team was to find the outcomes of the radiological outcomes after osteochondral allograft reconstruction for glenoid bone loss.
Full Article: Allograft Reconstruction for Glenoid Bone Loss in Glenohumeral Instability: A Systematic Review
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