This critical-analysis review covers the evaluation and surgical management of recurrent anterior glenohumeral instability with glenoid and humeral-head bone loss. It walks through quantifying bone loss, applying the glenoid track concept, and choosing among coracoid transfer, allograft, and remplissage.
When you see recurrent anterior instability, the decision is no longer just "repair the labrum." You have to measure the bone. Quantify glenoid loss on 3D-CT and place the Hill-Sachs lesion on the glenoid track. Bone loss at or above 20% (and arguably above 13.5%) plus an off-track lesion means a Bankart alone will fail.
The glenoid track is the mental model to carry into the OITE and clinic: on-track lesions can be ignored, off-track lesions must be addressed by widening the track (glenoid augmentation) or filling the defect (remplissage or humeral reconstruction).
Match the graft to the defect: coracoid transfer or iliac crest for glenoid loss, distal tibial allograft for large or revision glenoid defects, and allograft or resurfacing for humeral defects ≥40%.
Remember the trade-off in throwers, where both Latarjet and remplissage cost external rotation. The authors are explicit that critical bone loss thresholds remain debated, so treat these numbers as guides, not absolutes.
This critical-analysis review covers the evaluation and surgical management of recurrent anterior glenohumeral instability with glenoid and humeral-head bone loss. It walks through quantifying bone loss, applying the glenoid track concept, and choosing among coracoid transfer, allograft, and remplissage.
When you see recurrent anterior instability, the decision is no longer just "repair the labrum." You have to measure the bone. Quantify glenoid loss on 3D-CT and place the Hill-Sachs lesion on the glenoid track. Bone loss at or above 20% (and arguably above 13.5%) plus an off-track lesion means a Bankart alone will fail.
The glenoid track is the mental model to carry into the OITE and clinic: on-track lesions can be ignored, off-track lesions must be addressed by widening the track (glenoid augmentation) or filling the defect (remplissage or humeral reconstruction).
Match the graft to the defect: coracoid transfer or iliac crest for glenoid loss, distal tibial allograft for large or revision glenoid defects, and allograft or resurfacing for humeral defects ≥40%.
Remember the trade-off in throwers, where both Latarjet and remplissage cost external rotation. The authors are explicit that critical bone loss thresholds remain debated, so treat these numbers as guides, not absolutes.