IC 02-2025 Innovations in the Treatment of Bone Loss in Anterior Instability (CME)-IC 02-2025 Innovations in the Treatment of Bone Loss in Anterior Instability (CME)

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Video Summary

This panel discussion addresses the complexities of shoulder instability treatment, particularly regarding bone loss and surgical approaches. The speakers, esteemed shoulder surgeons, highlight that revision arthroscopic Bankart repairs have high failure rates (~44%), stressing the importance of selecting the right procedure initially. Early surgical repair is favored to optimize soft tissue quality and reduce recurrence. Bone loss, even at subcritical levels (~13.5%), significantly impacts outcomes and can't be ignored.<br /><br />Open Bankart repair remains a viable option, especially for collision athletes and revisions, providing low recurrence when performed expertly, though it involves challenges like subscapularis management and risk to nerves. The newer dynamic anterior stabilization (DAS) using the long head of the biceps offers a promising arthroscopic alternative, with good outcomes and fewer nerve injuries.<br /><br />The Latarjet procedure is considered gold standard for significant bone loss but carries risks like nerve injury and arthritis; its adoption is limited by technical difficulty and complication risk. Advances include arthroscopic bone grafting techniques such as arthroscopic anatomic glenoid reconstruction (AAGR) using distal tibial allograft. AAGR is promising due to less invasiveness, preservation of anatomy, low complication rates, and remote teaching capabilities, with long-term follow-up showing stable grafts despite remodeling.<br /><br />Fixation techniques—screws versus suture buttons—are debated; buttons may reduce complications but have had mixed results. Optimizing graft size to avoid oversizing reduces hardware issues. Managing the glenoid track, including remplissage for Hill-Sachs lesions, is crucial, especially when bone loss exceeds 10%. Authors advocate for individualized treatment balancing anatomy restoration, surgical risks, and patient activity level, particularly considering “consequence athletes” exposed to high-risk environments.<br /><br />Innovative techniques like the “autobridge” bone graft augment Bankart repairs in subcritical bone loss, showing promising early outcomes. Overall, the field is evolving toward safer, reproducible, less invasive surgeries that combine bony stability with anatomic preservation, although long-term data and consensus on optimal graft materials and fixation continue to develop.

Keywords

shoulder instability

bone loss

Bankart repair

revision surgery

dynamic anterior stabilization

Latarjet procedure

arthroscopic anatomic glenoid reconstruction

glenoid track management

Hill-Sachs lesions

autobridge bone graft