title: Surgical technique arthroscopic posterior glenoidplasty for posterosuperior glenoid impingement in throwing athletes.
abstract: BACKGROUND
  Posterosuperior glenoid impingement (PSGI) is the repetitive impaction of the supraspinatus tendon insertion on the posterosuperior glenoid rim in abduction and external rotation. While we presume the pain is mainly caused by mechanical impingement, this explanation is controversial. If nonoperative treatment fails, arthroscopic débridement of tendinous and labral lesions has been proposed but reportedly does not allow a high rate of return to sports. In 1996, we proposed adding abrasion of the bony posterior rim, or glenoidplasty.
  
  
  METHODS
  After arthroscopic assessment of internal impingement in abduction-extension-external rotation, extensive posterior labral and partial tendinous tear débridement is performed. Glenoidplasty involves recognition of a posterior glenoid spur and when present subsequent abrasion with a motorized burr.
  
  
  METHODS
  We retrospectively reviewed 27 throwing athletes treated between 1996 and 2008. Age averaged 27 years. CT arthrogram showed bony changes on the posterior glenoid rim in 21 shoulders. We evaluated 26 of the 27 patients at a minimum followup of 19 months (mean, 47 months; range, 19-123 months).
  
  
  RESULTS
  Eighteen of the 26 patients resumed their former sport level. Six improved but had to change to an inferior sport level or another sport. Two patients did not improve after the procedure, one of whom changed sport practice. There were no complications or posterior instability. In the 15 patients who had radiographs at followup times from 20 to 87 months, we observed no arthritis or osteophyte.
  
  
  CONCLUSIONS
  Comparison with an earlier series of soft tissue débridement shows glenoidplasty improves the likelihood of resuming a former sport level in patients with PSGI.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Clinique du Parc Lyon, 155 Boulevard de Stalingrad, Lyon, Rhone, 69006, France. c.levigne@cliniqueduparclyon.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Lévigne
authors.forename: Jérome
authors.initials: J
authors.lastname: Garret
authors.forename: Sophie
authors.initials: S
authors.lastname: Grosclaude
authors.forename: Florent
authors.initials: F
authors.lastname: Borel
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012090:Cumulative Trauma Disorders / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult