This systematic review pooled 17 studies (269 shoulders) on posterior glenoid bone block augmentation for recurrent posterior shoulder instability. It asked whether the procedure reliably restores stability and how its complication rates compare to other glenoid augmentation procedures. The review synthesized descriptive data, since heterogeneity prevented statistical pooling.
Reserve posterior glenoid bone block augmentation for the difficult case: revision instability, significant posterior bone loss, or incompetent posterior soft tissue. It is not a first-line procedure, and this review shows it does not reliably restore stability.
When you do use bone block, position matters. Posterior instability causes posteroinferior bone loss, so a subequatorial, flush graft best recreates native anatomy. A laterally prominent graft can erode the humeral head.
Fixation matters too. Screw fixation drove symptomatic hardware rates as high as 67%, while suture anchor fixation avoided it entirely in one series. If you fix a posterior bone block, favor a construct that minimizes prominent hardware.
Remember the 20% posterior bone loss threshold from cadaveric work, above which soft tissue repair alone fails. The 13.5% subcritical figure is borrowed from anterior data and is not yet validated posteriorly.
This systematic review pooled 17 studies (269 shoulders) on posterior glenoid bone block augmentation for recurrent posterior shoulder instability. It asked whether the procedure reliably restores stability and how its complication rates compare to other glenoid augmentation procedures. The review synthesized descriptive data, since heterogeneity prevented statistical pooling.
Reserve posterior glenoid bone block augmentation for the difficult case: revision instability, significant posterior bone loss, or incompetent posterior soft tissue. It is not a first-line procedure, and this review shows it does not reliably restore stability.
When you do use bone block, position matters. Posterior instability causes posteroinferior bone loss, so a subequatorial, flush graft best recreates native anatomy. A laterally prominent graft can erode the humeral head.
Fixation matters too. Screw fixation drove symptomatic hardware rates as high as 67%, while suture anchor fixation avoided it entirely in one series. If you fix a posterior bone block, favor a construct that minimizes prominent hardware.
Remember the 20% posterior bone loss threshold from cadaveric work, above which soft tissue repair alone fails. The 13.5% subcritical figure is borrowed from anterior data and is not yet validated posteriorly.