Long-term Outcome after Posterior Opening Glenoid Wedge Osteotomy for Posterior Shoulder Instability Associated with Excessive Glenoid Retroversion.

Treatment of posterior shoulder instability (PSI) associated with excessive glenoid retroversion is a rare, challenging problem in shoulder surgery. One proposed technique is posterior opening wedge glenoid osteotomy to correct excessive glenoid retroversion as described by Scott. However, this operation is rarely performed and limited long-term outcomes using this approach are available. It was the goal to analyze long-term outcome of posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion.
Six consecutive patients (7 shoulders) with a mean age of 24 (range, 19-34) years were treated with posterior open wedge glenoid osteotomy for PSI associated with a glenoid retroversion greater than 15° and followed-up clinically and radiographically at a mean of 15 (range, 10-19) years.
Recurrent, symptomatic PSI was observed in 6 out of 7 shoulders (86%). One necessitated revision with a posterior (iliac crest) bone block procedure and was rated as a failure and excluded from functional analysis. One patient rated his result as excellent, 3 as good, 1 as fair and 1 as unsatisfactory. Mean relative Constant Score (CS%) was unchanged from preoperatively to final follow-up (CS%: 72%) and pain did not significantly decrease (Constant pain scale: 7 to 10 points; p=0.969). The mean Subjective Shoulder Value (SSV) was improved postoperatively but with 7 patients the improvement did not reach statistical significance (SSV: 42% to 67%; p=0.053) and the total WOSI score averaged 30% at the final follow-up. Mean glenoid retroversion of all 7 shoulders was corrected from 20° (Range, 16-26°) to 3° (range, (-)3-(+)8°; p=0.018). In the five shoulders with preoperative static posterior subluxation of the humeral head (PSH), the humeral head was not recentered. All seven shoulders showed progression of glenoid arthritic changes.
Posterior open wedge glenoid osteotomy for PSI associated with excessive glenoid retroversion did neither reliably restore shoulder stability nor recenter the joint or prevent progression of osteoarthritis. Alternative treatments for PSI associated with excessive glenoid retroversion have to be developed and evaluated.

Copyright © 2021. Published by Elsevier Inc.