Chapter 3 Instability

132

CHAPTER 3 | Instability

are adhered to, we have not observed an increased recur- rence rate in contact athletes treated arthroscopically. 3,4 We believe that the critical factor for recurrence is recognizing significant bone loss and treating it appropriately. Latarjet Significant Bone Loss:When Is Latarjet Necessary? On the glenoid side, we consider that a patient has signifi- cant bone loss if he or she has lost ≥ 25% of the inferior gle- noid diameter. This can be determined from 3D CT scans, comparing the diameters of the injured and normal gle- noids (Fig. 3-3). In utilizing this modality, one must be cog- nizant that this method underestimated the percentage of bone loss in 8% of patients. 5 Therefore, we continue to pre- fer direct arthroscopic measurement of glenoid bone loss based on the location of the glenoid bare spot (Fig. 3-4). In terms of glenoid bone loss, our indication for a Latarjet reconstruction with coracoid bone graft is anterior instability associated with a glenoid bone loss of ≥ 25% of the inferior glenoid diameter. We have found that whenever we do a Latarjet reconstruction, the Hill-Sachs lesion does not need to be separately addressed. That is, after Latarjet, the coracoid bone graft and the sling effect of the conjoined tendon will always prevent the Hill-Sachs lesion from engaging, no matter how large the Hill-Sachs might be.

Video 3-1

Figure 3-2  ( Continued ) C: A positive test at 90° abduction indicates that the inferior glenohumeral ligament (IGHL) has been damaged.

FIGURE 3-3  Glenoid bone loss can be quantified with a three-dimensional CT of the (A) normal and (B) affected shoulders. The percentage of glenoid bone loss can be easily calculated on the en face view by comparing the inferior glenoid diameter of the normal side to that of the affected side.