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Αρθροσκοπική αποκατάσταση
οστικών ελλειμμάτων ωμογλήνης με
λαγόνιο μοσχευμα
Μάνος Αντωνογιαννακης
Ορθοπαιδικός Χειρουργός
Διευθυντής Γ΄Ορθοπαιδικής Κλινικής -
Κέντρου Αρθροσκόπησης & Χειρουργικής Ώμου
Γενικό Νοσοκομείο Υγεία

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Shoulder dislocation
With Bone Defects
Disclosures
Zimmer Biomet SportsMed course - Invited Speaker
7th Balkan Congress of Arthroscopy, Sports, Traumatology & Knee Surgery
Thessaloniki 2016 .

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The Shoulder
 Greatest Range of Motion in the Body
 Motion in all 3 planes of movement
 Prone to instability
Sacrifices stability for mobility

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What is Instability
 Biomechanical Dysfunction
 Failure of static and dynamic stabilizers
 Ranges from mild subluxation to
traumatic dislocation

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Contributors to stability
Static stabilizers
1. ligamentous structures labrum and
capsule
2. bony configuration of glenoid and
humeral head
Dynamic stabilizers
1. rotator cuff
2. scapula muscles

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Bone Defects
 Glenoid side
 Humeral side

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Humeral Bone Defects
Hill-Sachs lesion

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Humeral Bone Defects
Engaging
Non Engaging

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Engaging Hill Sachs

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Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
A.Three-dimensional CT scan with en face view of a normal glenoid, with subtraction of the humeral head
The width of the glenoid track without a glenoid defect is 83% of the glenoid width.
B. Relation of glenohumeral joint in abduction and external rotation.
The distance from the medial margin of the contact area (M) to the medial margin of the cuff footprint (F) is 83%±14%
of the glenoid width: F - M = 83% of glenoid width = glenoid track.

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Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion:
From “Engaging/Non-Engaging” Lesion to “On-Track/Off-Track” Lesion
Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart
A. 3D CT scan with en face view of a glenoid with bone loss of width d.
In such a case with glenoid bone loss, the glenoid track will be 83% of the normal glenoid width minus d.
B. Relation of glenohumeral joint in abduction and external rotation.
One should note the loss of contact of the intact humeral articular surface with the articular surface of the glenoid.
In this case the large Hill-Sachs interval (i.e., distance from posterior rotator cuff attachments to medial margin of Hill-
Sachs lesion) is wider than the glenoid track, whose width has been reduced because of the glenoid bone loss.

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From engaging Hill Sachs to On-track
& Off-track lesions
No Bone Loss Arthroscopic Bankart Repair
Glenoid Bone Loss
> 25%
Arthroscopic Bankart Repair + Bone grafting procedure
What
happens in
between?
It is the combination of the existing lesions
Large Hill-Sachs lesion + No glenoid bone loss
=
Small Hill-Sachs lesion + 15% -20% glenoid bone loss

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Hill- Sachs Remplisage: An arthroscopic surgical
solution for the engaging Hill-Sachs
E.M. Wolf
Remplissage

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Glenoid Bone Defects

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The inferior 2/3 of the glenoid is nearly a perfect
circle with avg diameter 24mm
Huysman et al. JSES 2006

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Normal Glenoid
inverted
pear
Bony Bankart
pear
Compression
Bankart
loss of
anterior rim

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Loss of 8.6mm of anterior radius of glenoid at
the level of the bare spot corresponds to 35%
of the normal anteroposterior width
Lo, Burkhart Arthroscopy 2004

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>25 – 30% bone loss 6.5 – 8.6mm AP width
Inverted pear appearance
Bone block procedures
Piasecki et al. AAOS J17 (8): 482. (2009)

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 Glenoid Index in 3D CT scan of both shoulders
SS Burkhart Arthroscopy: Vol 24, No 4 (April), 2008: pp 376-382

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 Taverna et al. Pico Method 2D CT – measurement of
glenoid surface Critical Limit 25% loss of glenoid
surface

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Our practice
The percentage of the glenoid defect was evaluated
on the en face reconstructed view with the humeral
head eliminated
Sugaya et al (2005) Joint Surg Am

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Glenoid Bone Loss >25%
Arthroscopic Latarjet procedure
L. Lafosse
Arthroscopic shoulder stabilization with a bone
block
E. Taverna

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E.Taverna, et.al,Knee
Surg Sports Traumatol
Arthrosc (2008)
16:872–875

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Arthroscopic Bone Block
combined with Remplissage

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3 months
Post-op

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3 months
Post-op

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3 months
Post-op

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 6 months Post-op

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OUR EXPERIENCE
23 cases
Impressive early outcomes

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OUR RESULTS
23 patients (22M, 1F)
 Average age: 32.87 (range 18-51)
 Average fu: 6,8 months (range 2-24)
 Dominant side : 60.87% (14/23)
 21 sport, (17 recreational,
4 competition)
 General laxity: 15/24
 Average glenoid bone loss : 10,5 %
 Average Hill-Sachs : 2,25 cm

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FUNCTIONAL RESULTS
Recurrence Rate 0%
Walch-Duplay Score (max 100 points) 94,2 ± 4 ,3 SD (range 85 – 100)
Rowe Score (max 100 points) 84,2 ± 6,4 SD (range 70 – 100)
ASES ( max 100 points ) 87,8 ± 12,1 SD (range 83 – 100)
SD: Standard Deviation

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76
78
80
82
84
86
88
ASESPRE ASESPOST
81
87,8

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0
10
20
30
40
50
60
70
80
90
ROWEPRE ROWEPOST
45,2
84,2

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0
5
10
15
20
25
30
35
40
OXFPRE OXFPOST
25,7
39,3

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0
10
20
30
40
50
60
70
80
90
100
WALCHPRE WALCHPOST
54,5
94,2

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170 172
89
78 82 73
0
20
40
60
80
100
120
140
160
180
200
FF PRE-OP FF POST-
OP
EXT90
PRE-OP
EXT90
POST-OP
EXT0 PRE-
OP
EXT0
POST-OP

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Preliminary outcomes
 Impressive outcomes
 BUT Mean follow up 6.8 months
 Pain free full ROM after 4 months
( 2 pts with stiffness resolution at 5
& 6 months respectively)

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Complications
 2 haematoma at the incision for the bone graft
self -resolution between 3-6 weeks after surgery
 2 fractures of bone , stabilized with 1 button but
healed in proper position
 No bone block absorption

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Bone Block VS Soft Tissue Repair
• Lower Recurrence Rate
• Anatomic Reconstruction
of boney and soft tissue
lesions

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Bone Block VS Bristow-Latarjet
• Anatomical Procedure
• No tendineous transfer
• No Subscapularis split
• Perfect position of the glenoid boney
tunnels thanks to the guide

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Bone Block VS Bristow-Latarjet
• No complications due to
hardware (use of screws)
• No major neurovascular
complications
• Βridges are not burned in
case of reccurence

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Bone Block Technique: limits
BB weak point:
Capsular-labrum-
ligaments
Inconsinstency.
Bone defects
Arthroscopically assisted
Latarjet procedure
Conversion to

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Traumatic Glenohumeral Bone Defects and Their
Relationship to Failure of Arthroscopic Bankart
Repairs: Significance of the Inverted-Pear
Glenoid and the Humeral Engaging Hill-Sachs
Lesion
S.S. Burkhart and J. F. De Beer, M.D.
Arthroscopy,October 2000

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 Total group: 194 patients
 173 pt without significant bone defects :
7 pt sustained a recurrence (4%)
 21 pt with significant bone defects:
14 pt developed rec instability (67%)

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23 pt active military personel,
25y mean age 20-30% bone loss 7mm of ap width
34months mean fu,
14.2% rec rate
Mologne et al. AJSM 2007