title: Bone block procedures in posterior shoulder instability.
abstract: OBJECTIVE
  Posterior shoulder dislocation is often associated with bone defects. Surgical treatment is often necessary to address these lesions. The aim of the present systematic review was to analyse the available literature concerning bone block procedures in the treatment of bone deficiencies following posterior dislocation. In addition, the methodology of the articles has been evaluated through the Coleman methodology score.
  
  
  METHODS
  A systematic review of the literature was performed using the keywords "posterior shoulder instability", "posterior shoulder dislocation", "bone loss", "bone defect", "bone block", and "bone graft" with no limit regarding the year of publication. All English-language articles were evaluated using the Coleman methodology score.
  
  
  RESULTS
  Fifty-four articles were identified, and 13 articles met inclusion criteria. The initial cohort included 208 shoulders, and 182 were reviewed at an average follow-up of 72.7 months (±55.2). The average Coleman score was 57.2 (±8.0). The most lacking domains were the size of study population, the type of study, and the procedure for assessing outcomes. All the articles showed an increase in the outcome scores. Radiographic evaluation revealed degenerative changes such as osteoarthritis and graft lysis in most of the series.
  
  
  CONCLUSIONS
  This review confirms the lack of studies with good methodological quality. However, bone grafting is a reliable option since significant improvement in all scores is reported. Although a low incidence of recurrence is generally described, there are concerns that the results may deteriorate over time as evidenced by graft lysis and glenohumeral osteoarthritis in up to one-third of patients.
  
  
  METHODS
  Systematic review, Level IV.
authors.affiliation: Università degli Studi del Molise, Campobasso, Italy. simo.red@tiscali.it.|, Via Riccardo Zandonai 11, 00135, Rome, Italy. simo.red@tiscali.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Cerciello
authors.affiliation: Ospedale di Este, ULSS 17, Este, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Visonà
authors.affiliation: Shoulder and Elbow Surgeon Lexington Clinic Orthopedics - Sports Medicine Center, The Shoulder Center of Kentucky, Lexington, KT, USA.
authors.forename: Brent Joseph
authors.initials: BJ
authors.lastname: Morris
authors.affiliation: Università degli Studi del Molise, Campobasso, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Corona
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D010003:Osteoarthritis / Q000601:surgery*; D012783:Shoulder Dislocation / Q000601:surgery*; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000601:surgery*
keywords: Bone block; Bone defect; Bone graft; Bone loss; Posterior shoulder dislocation; Posterior shoulder instability