One area of controversy in shoulder surgery is when to perform a glenoid/shoulder socket augmentation procedure for shoulder instability. Joint stability is dictated by the bony anatomy, surrounding ligaments, and supporting muscles. After a shoulder dislocation it is common to tear the labrum (see Shoulder Labral Tear- Relevant Anatomy and Function). Sometimes the shoulder socket can also be damaged in the process and the lip of the shoulder socket, known as the glenoid, can break off. When this occurs, the surface area of the shoulder socket is reduced. A smaller shoulder socket can increase shoulder instability. When a large portion of the shoulder socket is involved, repairing the broken rim is important. When only a small portion of the bony socket is involved however, it is unclear if the lost shoulder socket surface area requires reconstruction.
Bird’s eye view of right shoulder and socket in cross-section. Augmentation of the damaged anterior aspect of the bone socket with bone graft and screw to treat shoulder instability.Controversy exists within the shoulder surgeon community as to the best approach. A recent article by Blonna et al, tackles the controversy head on. The authors attempt to compare the outcomes of an isolated arthroscopic labral repair (also known as a Bankhart repair, see post on labral repair for more detail) with open bony augmentation of the shoulder socket and labral repair (also known as a Bristow-Latarjet procedure) using a matched pairs retrospective study design.
The authors conclude arthroscopic labral repair (Bankhart repair) using anchors provided better return to sport, better external rotation in the throwing position, and better subjective perception of the affected shoulder compared with the open bone block socket reconstruction and labral repair (Bristow-Laterjet procedure). There was a small trend of unclear significance towards a greater re-dislocation rate with the arthroscopic repair however compared to the open bone block socket reconstruction procedure. With a larger study sample, it is possible the difference re-dislocation might have become even more apparent.
For our athletes that are trying to get back on the field as soon as possible, fast and safe return to play is the most relevant concern. There are few studies like Blonna et al. that compare the two techniques head to head that give us clear guidance. In my professional opinion, when the bone socket has minimal damage, my preference is still to perform the less morbid arthroscopic labral repair. If the shoulder re-dislocates after the labral repair, then I believe the bone block procedure for shoulder socket augmentation becomes more appealing. This study’s conclusion supports our approach. More work needs to be done however before we can arrive at a definitive consensus. Hopefully this insightful study will encourage more in depth investigation on the subject.