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Humeral and glenoid bone defects as factors
1. E. Mataragas, C. Vassos, N. Tzanakakis, G. Mouzopoulos,
C.K. Yiannakopoulos, Emm. Antonogiannakis
2nd
Orthopaedic Dpt. â Shoulder and Arthroscopy Unit,
IASO GENERAL Hospital
2. ï¶ Age of 1st
Dislocation
ï¶ Loose Joints
ï¶ Overhead Profession
ï¶ Overhead/Contact Sports
ï¶ Collagen Related Pathology
ï¶ Number of Dislocations
ï¶ Osseous Defects
Rockwood Ch A Jr., THE SHOULDER 4th
ED.
3. There is a well-recognized association between
osseous defects of the glenoid or humerus and
shoulder dislocation, which often leads to
recurrent instability.
Boileau P., J Bone Joint Surg Am. 2006 Aug;88(8):1755-63.
Lynch JR., J Shoulder Elbow Surg. 2009 Mar-Apr;18(2):317-28.
Burkhart SS., Instr Course Lect. 2009;58:323-36.
4. To evaluate humeral and glenoid bone loss, in
patients arthroscopically treated for shoulder
instability, as factors of recurrence.
5. ï¶ Retrospective, continuous, monocentric.
ï¶ Series of 114 patients from 2000-2008.
One surgeon performed all the procedures!
6. Glenoid Index in 3D CT scan of both shoulders
Critical Limit Glenoid index 0.75
SS Burkhart Arthroscopy: Vol 24, No 4 (April), 2008: pp 376-382
7. Taverna et al. Pico Method 2D CT â
measurement of glenoid surface Critical Limit
25% loss of glenoid surface
8. Scope on anterior portal, measurement of
anteroposterior defect width
Sugaya et al. JBJS Am 2005
13. ï¶Complete follow up existed for 92 patients.
ï¶Follow up ranged from 4-108 months (Mean=44).
ï¶Post op rehabilitation was supervised by a doctor
dedicated to shoulder problems.
ï¶Recurrence and functional outcome were
evaluated pre-op and post-op with the Rowe Zarins
Score.
14. Osseous Lesions:
Hill Sachs 97
(66 Large, 23 Medium & 8 Small)
Glenoid Bone loss 104
(16 Large, 59 Medium & 29 Small)
âInverted pearâ glenoid shape 13
âBonyâ Bankart Lesion 13
17. ï¶All 5 of them presented Hill Sachs lesions.
ï¶Their glenoid bone loss was measured as:
(2 Large, 2 Medium, 1 Small)
ï¶None showed âinverted pearâ glenoid shape.
ï¶None presented with joint hypermobility.
ï¶All 5 of them were into Overhead/Contact sports.
(2 Professional: Mean=15hr/w and 3 Amateur: Mean=2,5hr/w).
18. All 5 patients were reoperated arthroscopically
and have not showed recurrent instability so far.
19. Patient Satisfaction
87 Very Satisfied/ 5 Satisfied 94,6% / 5,4%
Return to Work 100%
Return to Sports
50 patients (mostly because they didnât try) 66,6%
20. Pre-Op Post-Op p
Rowe Zarins 33 95 < 0.05
Range of Scores
Pre-op: 15-80
Post-op: 80-100
21. At least in this series, it seems that humeral
and glenoid bone loss do not significantly
contribute to the recurrence of
arthroscopically treated shoulder instability.