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On-track/off-track Shoulder Instability

February 19, 2016

Contributors: Paolo Scarso, MD; Nicola De Gasperis, MD; Giovanni Di Giacomo, MD; Giovanni Di Giacomo, MD

Keywords: Bony Procedure

2016 AWARD WINNER Recent studies agree that glenoid bone grafting should be performed to manage anterior instability with glenoid bone loss comprising 25% or more of the inferior glenoid diameter (inverted-pear glenoid). An engaging Hill-Sachs lesion is a risk factor for recurrent anterior instability. We have developed a method (radiographic and arthroscopic) that uses the concept of the glenoid track to determine if a Hill-Sachs lesion will engage the anterior glenoid rim and result in anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is an off-track lesion. If the Hill-Sachs lesion does not engage, it is an on-track lesion. Based on our quantitative method, we developed a treatment paradigm with specific surgical criteria for all patients who have anterior instability with or without bipolar bone loss.

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