Correlation of Glenoid Concavity With Surgical Failure After Arthroscopic Stabilization for Recurrent Anterior Shoulder Instability

Abstract

Background:

Glenoid concavity compression by rotator cuff muscle contraction is one of the key mechanisms in the stability of the glenohumeral joint.

Purpose/Hypothesis:

The purpose of this study was to evaluate the effects of glenoid concavity, as represented by the bony shoulder stability ratio (BSSR) and other factors, including glenoid bone defect size, on the surgical failure of arthroscopic stabilization procedures for recurrent anterior shoulder instability. The authors also aimed to determine the critical value of BSSR. It was hypothesized that both glenoid concavity and glenoid bone defect size would be correlated with surgical failure, with glenoid concavity having a stronger correlation.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A total of 120 patients who underwent arthroscopic stabilization procedures for recurrent anterior shoulder instability were included. Patients with bony Bankart lesions were excluded to eliminate the postoperative effects of bony fragment restoration on the glenoid concavity. For each patient, variable factors including BSSR, glenoid bone defect size, presence of off-track Hill-Sachs lesions, and age at first dislocation were recorded. Chi-square analysis and Student t test were performed to analyze the effect of each variable on surgical failure. Multivariate logistic regression analysis was used to determine the combined effect of >2 variables on surgical failure. The critical value of BSSR was analyzed using a receiver operating characteristic curve.

Results:

Nine patients (7.5%) had recurrent instability requiring revision surgery. BSSR (patients with recurrence, 18.6% ± 19.4%; patients without recurrence, 41.8% ± 10.5%; P = .01), glenoid bone defect size (17.5% ± 3.6% vs 11.7% ± 7.0%; P = .02), age at the time of first dislocation (18.8 ± 3.9 years vs 22.0 ± 6.5 years; P = .04), and number of suture anchors used (4.1 ± 0.3 vs 5.8 ± 1.6; P < .001) showed significant differences between patients with and without surgical failure. Multivariate logistic regression analysis revealed surgical failure to be correlated with BSSR (odds ratio, 0.849; P = .02) and the number of suture anchors used (odds ratio, 0.070; P = .03). The critical value of BSSR was 29.3% (area under the curve, 0.84; 95% CI, 0.67-1.00; P < .001; sensitivity, 78%; specificity, 93%).

Conclusion:

Glenoid concavity is strongly correlated with surgical failure after arthroscopic stabilization procedures for anterior shoulder instability. The value of BSSR reflects shoulder instability caused by glenoid bone morphology more accurately than glenoid bone defect size.

Keywords

arthroscopy bone defects bony Bankart glenoid incorporation recurrent instability

Get full access to this article

View all access options for this article.

References

Bhatia

Kandhari

. How does anterior glenoid bone loss affect shoulder stability? A cadaveric analysis of glenoid concavity and bony shoulder stability ratio. J Shoulder Elbow Surg. 2022;31(3):553-560.

Boileau

Villalba

Hery

Balg

Ahrens

Neyton

. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755-1763.

Delgrande

Lonjon

Hardy

Schoch

Werthel

. Long-term results of arthroscopic Bankart repairs for anterior instability of the shoulder in patients aged thirty years or older. Int Orthop. 2021;45(6):1583-1589.

Di Giacomo

Itoi

Burkhart

. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90-98.

Ernstbrunner

Werthel

Hatta

, et al. Biomechanical analysis of the effect of congruence, depth and radius on the stability ratio of a simplistic “ball-and-socket” joint model. Bone Joint Res. 2016;5(10):453-460.

Gowd

Liu

Cabarcas

, et al. Management of recurrent anterior shoulder instability with bipolar bone loss: a systematic review to assess critical bone loss amounts. Am J Sports Med. 2019;47(10):2484-2493.

Haas

Plachel

Wierer

, et al. Glenoid morphology is associated with the development of instability arthropathy. J Shoulder Elbow Surg. 2019;28(5):893-899.

Launay

Choudhry

Green

, et al. Three-dimensional quantification of glenoid bone loss in anterior shoulder instability: the anatomic concave surface area method. Orthop J Sports Med. 2021;9(6):23259671211011058.

Maiotti

De Vita

De Benedetto

, et al. Clinical outcomes and recurrence rate of 4 procedures for recurrent anterior shoulder instability: ASA, remplissage, open, and arthroscopic Latarjet: a multicenter study. J Shoulder Elbow Surg. 2023;32(5):931-938.

10.

Mehl

Hedgecock

Otto

, et al. Glenoid version is associated with different labrum tear patterns in shoulder instability. J Shoulder Elbow Surg. 2020;29(8):1642-1649.

11.

Moroder

Damm

Wierer

, et al. Challenging the current concept of critical glenoid bone loss in shoulder instability: does the size measurement really tell it all? Am J Sports Med. 2019;47(3):688-694.

12.

Moroder

Ernstbrunner

Pomwenger

, et al. Anterior shoulder instability is associated with an underlying deficiency of the bony glenoid concavity. Arthroscopy. 2015;31(7):1223-1231.

13.

Moroder

Haniel

Quirchmayr

, et al. Effect of glenoid concavity loss on shoulder stability—a case report in a professional wrestler. BMC Musculoskelet Disord. 2016;17(1):357.

14.

Nakagawa

Hirose

Uchida

Tanaka

Mae

. Postoperative recurrence of instability after arthroscopic Bankart repair for shoulders with primary instability compared with recurrent instability: influence of bipolar bone defect size. Am J Sports Med. 2020;48(1):48-55.

15.

Park

Kang

Shin

. Factors related to patient dissatisfaction versus objective failure after arthroscopic shoulder stabilization for instability. J Bone Joint Surg Am. 2019;101(12):1070-1076.

16.

Park

Lee

Hyun

Shin

. Effects of bone incorporation after arthroscopic stabilization surgery for bony Bankart lesion based on preoperative glenoid defect size. Am J Sports Med. 2018;46(9):2177-2184.

17.

Park

Shin

. Minimal clinically important differences and correlating factors for the Rowe score and the American Shoulder and Elbow Surgeons score after arthroscopic stabilization surgery for anterior shoulder instability. Arthroscopy. 2019;35(1):54-59.

18.

Shaha

Cook

Song

, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719-1725.

19.

Shin

Kim

Jeon

Kwon

. Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair. Am J Sports Med. 2017;45(9):1975-1981.

20.

Souleiman

Zderic

Pastor

, et al. Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability. Knee Surg Sports Traumatol Arthrosc. 2022;30(11):3626-3633.

21.

Sugaya

Moriishi

Dohi

Kon

Tsuchiya

. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am. 2003;85(5):878-884.

22.

Verweij

LPE

van Spanning

Grillo

, et al. Age, participation in competitive sports, bony lesions, ALPSA lesions, > 1 preoperative dislocations, surgical delay and ISIS score > 3 are risk factors for recurrence following arthroscopic Bankart repair: a systematic review and meta-analysis of 4584 shoulders. Knee Surg Sports Traumatol Arthrosc. 2021;29(12):4004-4014.

23.

Wasserstein

Dwyer

Veillette

, et al. Predictors of dislocation and revision after shoulder stabilization in Ontario, Canada, from 2003 to 2008. Am J Sports Med. 2013;41(9):2034-2040.

24.

Wermers

Raschke

Wilken

Riegel

Katthagen

. The anatomy of glenoid concavity-bony and osteochondral assessment of a stability-related parameter. J Clin Med. 2021;10(19):4316.

25.

Wermers

Schliemann

Raschke

, et al. Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect. Knee Surg Sports Traumatol Arthrosc. 2021;29(8):2631-2639.

26.

Wolke

Herrmann

Krannich

Scheibel

. Influence of bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. Am J Sports Med. 2016;44(5):1131-1136.