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Shoulder instability and bony reconstructions

Introduction to shoulder instability

Shoulder instability is a common orthopaedic condition that can significantly impair joint function and quality of life. It occurs when the humeral head repeatedly dislocates or subluxates from the glenoid cavity. This leads to pain, muscle weakness and limited mobility.

Athletes, people with previous shoulder injuries and patients with congenital joint laxity are particularly affected. If conservative treatments such as physiotherapy or splinting are not sufficient, surgical intervention may be necessary. Bony reconstructions, including bone grafts and osteotomies, are proven techniques for long-term stabilization of the shoulder joint, especially in cases of significant bone defect or recurrent dislocation.

Shoulder instability and bony reconstructions

Causes of post-traumatic shoulder instability

Post-traumatic shoulder instability is usually caused by:

  • Acute dislocations - High-energy injuries (e.g. falls, sports accidents) can lead to dislocation of the shoulder, causing damage to soft tissue and bony structures.
  • Recurrent dislocations - After a single dislocation, the shoulder often remains unstable because the ligaments are weakened and the joint capsule is overstretched.
  • Hill-Sachs and bony Bankart lesions - These bony defects occur as a result of dislocations and affect the stability of the shoulder joint.
  • Glenoid bone defect - Significant bone loss of the glenoid increases the risk of chronic instability and often requires surgical reconstruction.

Overview of post-traumatic defects and their treatment

Post-traumatic shoulder instability is often associated with bone damage that causes permanent instability. The two most common defects are:

  • Hill-Sachs lesion - An impression of the humeral head caused by repeated dislocations.
  • Bony Bankart lesion - A fracture of the anterior inferior margin of the glenoid cavity leading to instability.

Depending on the severity of the defects conservative therapy may be sufficient. In cases with significant bone loss however, surgical procedures such as such as bone grafts or osteotomies are necessary.

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Reconstruction methods for shoulder instability

Bone transplants

Bone transplants are used to reconstruct glenoid bone defects and restore stability to the shoulder joint. The patient’s own or donor bone material can be used.

Types of bone grafts

  • Iliac crest graft - autologous bone from the pelvis for structural reinforcement of the joint socket.
  • Distal tibial allograft - donor bone as an alternative to iliac crest transplantation with similar biomechanical advantages.
  • Coracoid transfer (Latarjet procedure) - Transfer of the coracoid process to improve anterior shoulder stability.

Osteotomies

Osteotomies are surgical corrections of the bone structure that help to realign joint surfaces and ensure greater stability.

Objectives of osteotomy for shoulder instability:

  • Improving the shape of the joint socket
  • Enlargement of the support surface for the humeral head
  • Reduction of excessive translation of the humeral head

The Bristow-Latarjet procedure is a proven osteotomy technique in which the coracoid process is repositioned and the capsule is reinforced with the common tendon to improve anterior shoulder stability.

Advantages of bone reconstructions compared to other treatments

Compared to soft tissue-based repairs or conservative methods bony reconstructions offer several advantages:

  • Permanent stability - restoration of joint integrity and prevention of recurrent dislocations.
  • Improved shoulder function - Increased mobility and strength for a return to sporting activities.
  • Protection against further damage - reduction of the progression of degenerative changes in the joint.
  • High success rate - Proven effectiveness in long-term clinical studies.

Who can benefit from a bony reconstruction?

These procedures are particularly suitable for patients with:

  • Significant glenoid bone loss
  • Recurrent shoulder dislocations despite conservative therapy
  • Unsuccessful previous soft tissue repairs
  • High functional requirements (e.g. athletes, physically active people)
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Success rates and case studies

Clinical studies show that bone reconstruction procedures are very successful:

  • Over 90 % of patients achieve complete joint stability.
  • Significant reduction in dislocation rates after surgery.
  • Improved functional results and high patient satisfaction.

Especially Athletes and active patients benefit considerably, as after the operation they can can return to their activities without can return to their activities without restrictions.

Frequently asked questions

Complete rehabilitation takes 4 to 6 monthsdepending on the individual healing phase and physiotherapy.

Most patients report considerable improvement in strength and mobilityas long as they follow the rehabilitation program consistently.

Yes, both autologous as well as allogeneic transplants are proven procedures with low risk of complicationswhen performed by experienced surgeons.

In principle, yes – however, suitability depends on general health and the joint situation of the patient.

In contrast to soft tissue repairs, bony reconstruction offers long-term stabilityespecially in the case of significant bone defects.

Contact for further information

If you suffer from shoulder instability and would like to explore your treatment options, contact me for a personalized consultation.

The following languages are spoken in my ordination:

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My ordination in 1190 Vienna
My ordination in 1110 Vienna
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