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Defining Critical Glenoid Bone Loss In Posterior Shoulder Capsulolabral Repair


Justin W. Arner, MD
UNITED STATES

Defining Critical Glenoid Bone Loss In Posterior Shoulder Capsulolabral Repair

Justin W. Arner, MD, UNITED STATES Joseph J. Ruzbarsky, MD, UNITED STATES Kaare Midtgaard, MD, NORWAY Liam A. Peebles, BA, UNITED STATES James P. Bradley, MD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES

The Steadman Clinic, Vail, CO, UNITED STATES

2021 Congress   Abstract Presentation   5 minutes   Not yet rated

 

Anatomic Location

Shoulder Glenohumeral

Diagnosis / Condition

Instability

Treatment / Technique

Repair / Reconstruction

Anatomic Structure

Ligaments Labrum

Diagnosis Method

Arthro-MRI

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Summary: Risk factors for failure of arthroscopic posterior shoulder capsulolabral repair include smaller glenoid bone width and greater glenoid bone loss percentage. A threshold of 11% posterior glenoid bone loss implicated a 10 times higher surgical failure rate while a threshold of 15% lead to a 25 times higher surgical failure rate.

Background

Although critical bone loss for anterior instability is well defined, a clinically significant threshold of posterior bone loss has not been elucidated.

Hypothesis

Patients who fail arthroscopic posterior shoulder capsulolabral repair will have increased posterior glenoid bone loss with a defined critical threshold.
Study Design: Case-Control

Methods

Athletes greater than 18 years of age with unidirectional posterior instability treated with arthroscopic repair were evaluated at 2 year minimum follow-up. Failure was defined as revision surgery, ASES <60, or subjective stability score >5. MRIs measurements from 19 patients who failed arthroscopic posterior shoulder capsulolabral repair were compared with 56 patients who did not. MRIs measures included glenoid version, labral version, glenoid width, labral width, percent bone loss using the circle technique, labral height, percent subluxation, and recently described measures of defect slope, bone loss angle, and defect length. The p-value threshold was set at 0.05 and a multivariable logistic regression analysis was performed for evaluation of risk of surgical failure.

Results

Smaller glenoid width and greater percent glenoid bone loss (25.5 + 0.68 mm vs 28.8 + 0.47 mm, p<0.001; 6.8 + 0.64% vs 4.6 + 0.43%, p=0.008) was seen in those that failed surgery. There was no difference in glenoid version or other measurements between the failures and non-failures. A cutoff of 11% glenoid bone loss resulted in a 10 times statistically higher surgical failure rate, while 15% bone loss resulted in a 25 times statistically higher failure rate. Six patients had bone loss greater than 11% (range, 11.1 - 19.3) and 1 patient had greater than 15% bone loss

Conclusion

Risk factors for failure of arthroscopic posterior shoulder capsulolabral repair include smaller glenoid bone width and greater glenoid bone loss percentage. A threshold of 11% posterior glenoid bone loss implicated a 10 times higher surgical failure rate while a threshold of 15% lead to a 25 times higher surgical failure rate. Surgical failure of posterior capsulolabral repair, however, is relatively rare as it is an overall successful intervention.

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