A 40-year-old man had painful static posterior shoulder subluxation with early eccentric osteoarthritis and a B1 glenoid. His acromion was abnormally high and horizontal and his glenoid inferiorly inclined versus a normal statistical shape model. The case tests whether restoring normal scapular anatomy with combined acromial and glenoid osteotomies can recenter the joint.
The etiology of eccentric glenohumeral OA in young adults has centered on glenoid retroversion, but version correction alone has not reliably prevented progression. This case reframes the problem: the acromion in static posterior subluxation is high and horizontal, losing its role as a posterior bony restraint during elevation.
The mental model to carry: when you see static posterior subluxation with a B1 glenoid in a young patient, look at acromial morphology, not just glenoid version. The combined "SCOPE" osteotomy corrected both the acromial tilt and glenoid retroversion, recentered the joint on CT, and produced a normal pain-free shoulder at 2 years.
Read this as hypothesis-generating, not practice-changing. It is a single experimental case with 2-year follow-up, and whether recentering actually prevents OA progression is explicitly unresolved.
A 40-year-old man had painful static posterior shoulder subluxation with early eccentric osteoarthritis and a B1 glenoid. His acromion was abnormally high and horizontal and his glenoid inferiorly inclined versus a normal statistical shape model. The case tests whether restoring normal scapular anatomy with combined acromial and glenoid osteotomies can recenter the joint.
The etiology of eccentric glenohumeral OA in young adults has centered on glenoid retroversion, but version correction alone has not reliably prevented progression. This case reframes the problem: the acromion in static posterior subluxation is high and horizontal, losing its role as a posterior bony restraint during elevation.
The mental model to carry: when you see static posterior subluxation with a B1 glenoid in a young patient, look at acromial morphology, not just glenoid version. The combined "SCOPE" osteotomy corrected both the acromial tilt and glenoid retroversion, recentered the joint on CT, and produced a normal pain-free shoulder at 2 years.
Read this as hypothesis-generating, not practice-changing. It is a single experimental case with 2-year follow-up, and whether recentering actually prevents OA progression is explicitly unresolved.