Bone defects are frequently observed in anterior shoulder instability. Over the last decade, knowledge of the association of bone loss with increased failure rates of soft-tissue repair has shifted the surgical management of chronic shoulder instability. On the glenoid side, there is no controversy about the critical glenoid bone loss being 20%. However, poor outcomes have been described even with a subcritical glenoid bone defect as low as 13.5%. On the humeral side, the Hill-Sachs lesion should be evaluated concomitantly with the glenoid defect as the two sides of the same bipolar lesion which interact in the instability process, as described by the glenoid track concept. We advocate adding remplissage to every Bankart repair in patients with a Hill-Sachs lesion, regardless of the glenoid bone loss. When critical or subcritical glenoid bone loss occurs in active patients (> 15%) or bipolar off-track lesions, we should consider anterior glenoid bone reconstructions. The techniques have evolved significantly over the last two decades, moving from open procedures to arthroscopic, and from screw fixation to metal-free fixation. The new arthroscopic techniques of glenoid bone reconstruction procedures allow precise positioning of the graft, identification, and treatment of concomitant injuries with low morbidity and faster recovery. Given the problems associated with bone resorption and metal hardware protrusion, the new metal-free techniques for Latarjet or free bone block procedures seem a good solution to avoid these complications, although no long-term data are yet available.

中文翻译：

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肩前不稳定中骨质流失的管理。


骨缺损常见于肩前不稳定。在过去的十年中，关于骨质流失与软组织修复失败率增加相关的知识已经改变了慢性肩关节不稳定的手术管理。在关节盂方面，关于临界关节盂骨流失为 20% 没有争议。然而，即使亚临界关节盂骨缺损低至 13.5%，也有不良结局的描述。在肱骨侧，Hill-Sachs 病变应与关节盂缺损同时进行评估，因为同一双极病变的两侧在不稳定性过程中相互作用，如关节盂轨迹概念所述。我们主张在 Hill-Sachs 病变患者的每次 Bankart 修复中增加 remplissage，无论关节盂骨丢失如何。当活动患者 （> 15%） 或双极偏离轨道病变发生危重或亚临界关节盂骨丢失时，应考虑前关节盂骨重建。在过去的二十年里，这些技术取得了长足的发展，从开放手术发展到关节镜手术，从螺钉固定发展到无金属固定。关节盂骨重建手术的新关节镜技术可以精确定位移植物、识别和治疗伴随损伤，发病率低，恢复更快。鉴于与骨吸收和金属硬件突出相关的问题，用于 Latarjet 或游离骨阻滞手术的新型无金属技术似乎是避免这些并发症的良好解决方案，尽管目前还没有长期数据可用。