Glenoid Track Concept vs Humeral Head Engagement in Recurrent Anterior Shoulder Instability with Glenoid Bone Loss Less Than 25%
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- Category: Vol. 85, September 2017
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Glenoid Track Concept vs Humeral Head Engagement in Recurrent Anterior Shoulder Instability with Glenoid Bone Loss Less Than 25%, MAHER AL-ASSAL, MOHAMMED M. ABD AL-HAMID, HATEM G. SAID, MAYSARA A. BAYOUMY and AHMED ZOALFAKAR MOHAMED
Abstract
Background: Arthroscopic Bankart repairs are now widely used to treat patients with traumatic unidirectional anterior shoulder instability. However, several studies have shown an increased failure rate after arthroscopic stabilization when bony defects were not addressed during surgery. Engagement of hills-sachs lesion was used to evaluate the need for further surgical procedure. The "glenoid track" concept was developed to assess the risk of engagement of a Hill-Sachs lesion in a patient with anterior shoulder instability.
The purpose of our study is to evaluate and compare on/ off track method versus classic engagement or non-engagement method.
Study Design: It is a retrospective/prospective study.
Methods: 62 patients were included in this study 59 males and 3 female 17 patients retrospective and 45 prospective with a Hill-Sachs lesion were included in the final Magnetic Resonance Image [MRI] and CT analysis. Bipolar bone loss measures of glenoid bone loss and multiple size measures of the Hill-Sachs injury were recorded. Based on the extent of the bipolar lesion, patients were classified with a glenoid track as off track or in track. The 2 groups were then compared with clinical evidence of engagement on Examination Under Anesthesia (EUA).
Results: All patients of this study presented with the glenoid bone defect of less than 25% glenoid diameter. By assessment of the 62 Hill-Sachs lesions, 22 (35.4%) were determined to be off track, the remaining 40 (64.5%) were on track. Arthroscopically, 17 of 22 (77.2%) lesions off tract engaged in a functional position when the shoulder was externally rotated in 90º of abduction versus only 5 of 40 (12.5%) on track.
Conclusion: This study demonstrates that glenohumeral engagement was well predicted based on preoperative glenoid and humeral head bone loss measurements using the glenoid track method.