Recurrent Shoulder Dislocation – What to do & When! – A Systematic Review
Keywords:Recurrent Instability, Shoulder, Bone Loss, CT Scan Measurement, Best-Fit Circle Method, Arthroscopy, Latarjet, Remplissage
The understanding of recurrent instability of the shoulder joint has been evolving in the past few years with surgeons treating the problem arthroscopically, even in the presence of significant bone loss in glenoid and humeral head. The aim of this article is to evaluate the various treatment methods and to elucidate the current best options for various types of shoulder dislocation. The success of treatment depends on meticulous preoperative evaluation including radiological assessment of soft tissues and, measurements of bone loss in the glenoid (Bankart lesion) and the humeral head (Hill-Sachs lesion). When the bone loss is less than clinically significant arthroscopic reattachment of the torn capsulo-labral complex (arthroscopic Bankart surgery) provides adequate stability to the joint. But when there is ‘significant bone loss’ in either bone, bony procedures like the Latarjet where coracoid bone is transferred to anterior glenoid, or iliac crest bone grafting, or other stabilizing procedures of the humeral head like the Remplissage are required. The concept of on-track off-track bipolar bone loss gives reproducible guidelines for bone loss assessment and planning the best treatment for stabilizing the shoulder joint. Although the traditionally accepted amount significant glenoid bone loss for bony procedures is >25%, recent studies by various authors quantify much lesser amounts of bone loss, up to 15% or even less, which make the shoulder unstable even after arthroscopic Bankart surgery in an athletic young individual, where bony procedures may have to be added to give good functional results.
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