title: Arthroscopic posterior bone block augmentation in posterior shoulder instability.
abstract: BACKGROUND
  Posterior instability is a relatively rare and challenging condition to treat. Soft-tissue procedures do not always provide satisfactory results. We present the results after arthroscopic posterior bone block augmentation with an iliac crest bone graft and a minimum of 12 months' follow-up.
  
  
  METHODS
  Between 2008 and 2009, we performed 19 arthroscopic posterior bone blocks on 18 patients with posterior instability (bilaterally in 1 patient). The mean age was 29.85 years at the time of surgery. The mean follow-up was 20.5 months. All patients had a painful, unstable shoulder. Preoperative etiology included trauma, glenoid dysplasia, Ehlers-Danlos syndrome, and arthrosis with posterior glenoid erosion.
  
  
  RESULTS
  The Rowe score improved from 18.4 points to 82.1 points, and the Walch-Duplay score improved from 37.4 points to 82.9 points, both statistically significant (P < .01). Radiologic bone healing was achieved in all cases. Nine cases had an excellent result with return to the previous level of sports, six were satisfied, and three had a persistently painful shoulder. Subsequent removal of screws improved symptoms in two of these patients, and in one patient, a cause for the pain and persistent instability was not found.
  
  
  CONCLUSIONS
  Arthroscopic posterior bone block augmentation presents a reliable technique for the treatment of symptomatic posterior instability with varying origin. Although this is a technically demanding procedure, in our experience, the potential benefits and minimally invasive nature outweigh the risks and benefits of more invasive procedures.
authors: Alps Surgery Institute, Clinique Générale d'Annecy, 4 Chemin de la Tour la Reine, Annecy, France. daniel.g.schwartz@gmail.com
authors: Daniel Grant
authors: DG
authors: Schwartz
authors: Sven
authors: S
authors: Goebel
authors: Kalman
authors: K
authors: Piper
authors: Bartlomiej
authors: B
authors: Kordasiewicz
authors: Simon
authors: S
authors: Boyle
authors: Laurent
authors: L
authors: Lafosse
mesh_terms: D000328:Adult; D001182:Arthroscopy; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D016268:Internal Fixators; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012785:Shoulder Joint; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bankart; Case Series; Latarjet; Level IV; Posterior glenohumeral instability; Treatment Study; arthroscopic reconstruction; bone loss; glenoid; shoulder