ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1836

 

Posterior Open Wedge Glenoid Osteotomy for Young Patients with Increased Retroversion and Posterior Shoulder Instability: Surgical Technique and Preliminary Results

Jonas Pogorzelski, MD, PhD, MHBA, Munich, Bavaria GERMANY
Andreas B. Imhoff, MD, Prof., Munich, Bavaria GERMANY
Sepp Braun, MD, PhD, Munich, Bavaria GERMANY
Jean M. Hovsepian, MD, Caracas, Miranda VENEZUELA
Taran Singh P. Singh, MD, MMed(Orth), Alor Setar, Kedah MALAYSIA
Lucca Lacheta, MD, Vail, CO UNITED STATES

Department of Sport Orthopedics, Technical University of Munich, Munich, Bavaria, GERMANY

FDA Status Not Applicable

Summary

Posterior open wedge glenoid osteotomy results in very satisfying outcomes in young patients with increased retroversion and symptomatic posterior shoulder instability, but patient selection and knowledge of the anatomy is critical.

Abstract

Background

and Purpose:
The relationship between symptomatic posterior shoulder instability (PSI) and increased glenoid retroversion (GR) has been documented. Open wedge posterior glenoid osteotomy (PGO) is a common treatment option for patients with increased GR, but outcomes in the literature are limited. Therefore, the purpose of this study was to report the clinical and radiological outcomes following PGO.

Methods

Patients that underwent PGO for symptomatic PSI with a GR angle of more than or equal to 10°, and were at least twelve months out from surgery, were included in the study. General data, medical history, radiographic data such as the GR angle were extracted from the patients’ hospital documentation notes. To evaluate postoperative outcome, the Rowe standard rating scale for shoulder instability and the Oxford shoulder instability score were collected retrospectively.

Results

In 12 shoulders (11 patients) the mean pre-operative GR was 23.3° (range, 10°-35°) and this reduced significantly (p=0.003) to a mean of 13° (range, 1°- 28°) post-operatively. At a mean follow up of 19.8 months (range, 14 – 36), the mean Rowe score was 85 points (range, 45-100 points) and the mean Oxford instability score was 40 points (range, 21-48 points). There were no post-operative re-dislocations or revision surgeries, however, one shoulder demonstrated signs of clinical recurrent instability and four asymptomatic radiological complications occurred.

Conclusion

Our technique of open wedge posterior glenoid osteotomy combined with posterior capsular shift provided reliable, preliminary clinical results with a low rate of clinical failure in a stringently selected patient cohort. However, due to the risk of complications, we advocate this procedure for experienced shoulder surgeons, who are familiar with its anatomical and technical considerations.