Recurrent shoulder dislocations do not only tear soft tissue. Over time, each dislocation chips away at the front of the glenoid socket, progressively eroding the bone that forms the anterior rim of the shoulder. This glenoid bone loss is one of the key reasons that standard soft tissue repair alone fails in certain patients with recurrent shoulder instability.
What is Glenoid Bone Loss?
The glenoid is the shallow socket of the scapula that forms one side of the shoulder joint. In patients with recurrent anterior shoulder dislocations, the repeated impact of the humeral head against the front glenoid rim causes progressive erosion of the anterior bone. When this bone loss exceeds 20 to 25 percent of the glenoid surface area, the shoulder is considered to have critical bone loss, and standard Bankart repair carries an unacceptably high recurrence rate.
Glenoid bone loss fundamentally changes the surgical plan. Restoring the glenoid bone surface becomes as important as repairing the labral tissue.
Types of Glenoid Bone Loss
Causes
Progressive glenoid bone loss occurs with each repeated dislocation. Patients who have sustained multiple dislocations over time, particularly those who have delayed seeking surgical treatment, are most likely to have significant bone deficiency. In some cases, a single high-energy dislocation can cause an acute fracture of the glenoid rim.
- History of multiple shoulder dislocations, often with progressively less force required for each subsequent episode
- Shoulder instability that recurs even after a previous Bankart repair
- Pain and apprehension with the arm in an overhead or externally rotated position
Diagnosis
CT scan, particularly with 3D reconstruction and en-face views of the glenoid, is the gold standard for quantifying glenoid bone loss and determining whether the critical threshold has been reached. This is essential for surgical planning.
Treatment
Open Latarjet Procedure
The open Latarjet procedure is the gold standard for shoulder instability with critical glenoid bone loss. Dr. Kushalappa transfers a piece of the coracoid bone, along with its conjoined tendon, to the front of the glenoid. This simultaneously restores the glenoid bone surface area and provides a dynamic soft tissue sling against re-dislocation. The coracoid is fixed to the glenoid neck using screws. The procedure provides extremely reliable long-term stability even in contact athletes, which is why it is the preferred choice for patients with significant bone deficiency.
Why Choose Dr. Kushalappa Subbiah in Bangalore?
Dr. Kushalappa Subbiah completed a Fellowship in Shoulder Surgery at the Sydney Shoulder Research Institute, where he trained in advanced arthroscopic shoulder procedures including labral repair and reconstruction. He holds the International Olympic Committee (IOC) Diploma in Sports Medicine, and has direct clinical experience managing shoulder injuries in Indian athletes across cricket, swimming, tennis, and contact sports. He is appointed as a Consultant Shoulder Surgeon at NH Hospital, Bangalore.