This narrative review revisits and updates the glenoid track concept for assessing bipolar bone loss in anterior shoulder instability. It asks how to measure the track most accurately and how to fold in non-bony risk factors when deciding between soft tissue repair and bony procedures. It covers on-track/off-track definitions, the peripheral-track gray zone, CT versus MRI measurement, and the GTIMS scoring system.
Assess Hill-Sachs risk against glenoid bone loss together, never in isolation. A defect that is harmless with an intact glenoid can engage once glenoid bone is lost, which is the whole reason the glenoid track concept exists.
Remember why the old engaging-lesion dynamic exam was abandoned: before Bankart repair the unstable head slides anteriorly and produces pseudo-engagement. The valid test only works after repair, which makes it useless for planning remplissage beforehand.
For management, an off-track HSL is a contraindication to isolated Bankart repair and needs remplissage or a bone procedure. Watch the peripheral-track gray zone too: a lesion near the medial track edge behaves worse than its on-track label suggests. When you measure on MRI, know that conventional axial slices overcall off-track lesions. Use MRI to screen, then confirm borderline cases with 3D-CT.
This narrative review revisits and updates the glenoid track concept for assessing bipolar bone loss in anterior shoulder instability. It asks how to measure the track most accurately and how to fold in non-bony risk factors when deciding between soft tissue repair and bony procedures. It covers on-track/off-track definitions, the peripheral-track gray zone, CT versus MRI measurement, and the GTIMS scoring system.
Assess Hill-Sachs risk against glenoid bone loss together, never in isolation. A defect that is harmless with an intact glenoid can engage once glenoid bone is lost, which is the whole reason the glenoid track concept exists.
Remember why the old engaging-lesion dynamic exam was abandoned: before Bankart repair the unstable head slides anteriorly and produces pseudo-engagement. The valid test only works after repair, which makes it useless for planning remplissage beforehand.
For management, an off-track HSL is a contraindication to isolated Bankart repair and needs remplissage or a bone procedure. Watch the peripheral-track gray zone too: a lesion near the medial track edge behaves worse than its on-track label suggests. When you measure on MRI, know that conventional axial slices overcall off-track lesions. Use MRI to screen, then confirm borderline cases with 3D-CT.