Glenoid and humeral head bone loss in traumatic anterior glenohumeral instability: a systematic review.

PURPOSE: The aim of this systematic review is to analyze outcomes of surgical procedures for glenoid and/or humeral bony defects, performed singularly or in combination, in patients with traumatic anterior glenohumeral instability. A secondary aim is to establish in clinical settings which percentage of glenoid or humeral bone loss needs to be treated with a bony procedure to avoid recurrence of dislocation. METHODS: A systematic review of the literature according to the PRISMA guidelines was performed. A comprehensive search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using various combinations of the keywords "shoulder", "instability", "dislocation", "bone loss", "bony bankart", "osseous glenoid defects", "glenoid bone grafting", "Latarjet", "glenoid", "humeral head", "surgery", "glenohumeral", "Hill Sachs", "Remplissage", over the years 1966-2012 was performed. RESULTS: Twenty-seven articles, describing patients with glenoid bony defect, humeral bony defect or both in the setting of traumatic anterior glenohumeral instability, were included. A total of 1,816 shoulders in 1,801 patients were included, with a median age at surgery of 27.1 years, ranging from 12 to 75 years. Patients were assessed at a median follow-up period of 2.8 years (ranging from 6 months to 28.2 years). The overall recurrence of redislocation occurred in 117 (6.5 %) shoulders. The redislocation event occurred in 40 of 553 (7.2 %) shoulders with glenoid bony defect, in 30 of 225 (13.3 %) shoulders with humeral bony defect and in 63 of 1,009 (6.3 %) shoulders with both glenoid and humeral involvement. CONCLUSION: Even though the general principle of recognizing and treating glenoid and humeral bone defects in patients with traumatic anterior glenohumeral instability is widely accepted, few studies are available to date to accurately establish which bone defects should be treated with bone procedures and the exact percentage of bone loss leading to higher risk of redislocation in clinical settings.

Recurrent anterior shoulder instability: accuracy of estimations of glenoid bone loss with computed tomography is insufficient for therapeutic decision-making.

OBJECTIVE: To evaluate the reliability of glenoid bone loss estimations based on either axial computed tomography (CT) series or single sagittal ("en face" to glenoid) CT reconstructions, and to assess their accuracy by comparing with actual CT-based bone loss measurements, in patients with anterior glenohumeral instability. MATERIALS AND METHODS: In two separate series of patients diagnosed with recurrent anterior glenohumeral instability, glenoid bone loss was estimated on axial CT series and on the most lateral sagittal (en face) glenoid view by two blinded radiologists. Additionally, in the second series of patients, glenoid defects were measured on sagittal CT reconstructions by an independent observer. RESULTS: In both series, larger defects were estimated when based on sagittal CT images compared to axial views. In the second series, mean measured bone loss was 11.5% (SD = 6.0) of the total original glenoid area, with estimations of 9.6% (SD = 7.2) and 7.8% (SD = 4.2) for sagittal and axial views, respectively. Correlations of defect estimations with actual measurements were fair to poor; glenoid defects tended to be underestimated, especially when based on axial views. CONCLUSION: CT-based estimations of glenoid bone defects are inaccurate. Especially for axial views, there is a high chance of glenoid defect underestimation. When using glenoid bone loss quantification in therapeutic decision-making, measuring the defect instead of estimating is strongly advised.

Video analysis of the mechanisms of shoulder dislocation in four elite rugby players.

BACKGROUND: Shoulder injuries are common in rugby, with the most severe match injury being shoulder dislocation and instability. A limitation of epidemiological studies is that the injury information is based on player interviews after the injury or reports from the medical staff. The objective of this study is to describe the specific injury mechanisms for shoulder dislocation using video recordings in a consecutive series of 4 elite male rugby players who sustained an episode of shoulder dislocation during an official match. METHODS: Videotapes were reviewed to identify the mechanism of the injury. The incidents, including the play leading up to each incident, were analysed. A shoulder dislocation mechanism score was developed to describe the injury mechanism and the events leading up to the injury. RESULTS: For all the athletes, player-to-player contact was responsible for the shoulder dislocation. Three of the four injuries resulted from trauma with the elbow in an extended position forcing the shoulder to exceed the limits of the normal range of motion, causing anterior shoulder dislocation. One injury resulted from trauma with the elbow in a flexed position and the direction of the injuring force along the longitudinal axis of the humerus causing posterior shoulder dislocation. CONCLUSIONS: This study provides preliminary evidence that thorough video analysis can provide detailed information about the mechanisms of shoulder dislocation in elite rugby players. Knowledge of the common mechanisms of injuries in these athletes may potentially lead to improved sports technique to attempt to reduce the occurrence of shoulder dislocations. Further studies with a larger number of patients are required to better clarify the exact mechanism of shoulder dislocation in rugby players, and how these results may be applied in training and matches to prevent shoulder dislocation in elite rugby players.