Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique

Luciano Andrés Rossi, Rachel M. Frank, David Wilke, CAPT Matthew T. Provencher, Peter J. Millet, Anthony Romeo, Gilles Walch, Ian Lo, Nobuyuki Yamamoto, Desmond Bokor, Giovanni Di Giacomo, John Tokish, Osvandre Lech, Eiji Itoi, Grant Garrigues, Markus Scheibel, Pascal Boileau, Emilio Calvo, Guillermo Arce, Felipe ToroHiroyuki Sugaya, Maximiliano Ranalletta, Stephen Parada, Felix Savoie, Nikhil N. Verma, Jorge Chahla

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss. Methods: A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus. Results: After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. Conclusions: The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed. Level of Evidence: Level V, consensus statement.

Original languageEnglish
Pages (from-to)1719-1728
Number of pages10
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume37
Issue number6
DOIs
Publication statusPublished - 2021 Jun
Externally publishedYes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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