Article Text

Download PDFPDF
How to handle minor and major bone loss in the shoulder? Current concepts
  1. Giovanni Di Giacomo1,
  2. Mattia Pugliese2,
  3. Denny Tjiauw Tjoen Lie3,
  4. Andrew Chia Chen Chou3,
  5. Jiwu Chen4,
  6. Nahum Rosenberg5,
  7. Eiji Itoi6
  1. 1 Concordia Hospital, Roma, Italy
  2. 2 Department of Trauma and Orthopaedics, Sapienza University of Rome, Roma, Italy
  3. 3 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
  4. 4 Huashan Hospital Fudan University, Shanghai, China
  5. 5 Technion Israel Institute of Technology, Haifa, Israel
  6. 6 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Aoba-ku, Sendai, Japan
  1. Correspondence to Dr Giovanni Di Giacomo, Concordia Hospital, Roma 00145, Italy; concordia{at}


Anterior shoulder instability is a significant problem in orthopaedic surgery. It carries a heavy burden on quality of life, especially in young, active patients. Surgical treatment is therefore often carried out in this population. Several strategies can effectively address this issue. Yet, the consensus is lacking on the parameters which favour one technique over another, especially when bone loss is present. This is because of the complex, dynamic interplay between bone loss on the humeral side (ie, Hill-Sachs lesion) and glenoid bone loss, which is a common occurrence and defined as ‘bipolar’. There is an ongoing debate over the percentage of glenoid bone loss warranting bone block procedures: 13.5–15% is an indicator for such procedures (ie, Latarjet), although this value is still considered controversial and not uniformly accepted. A multitude of other factors (ie, age, sex, level of activity and so on) come into play alongside bipolar bone loss and the weight of each factor has yet to be fully elucidated. Also, refining the algorithm for the right procedure in the right patients will reduce the number of side effects stemming from initial, suboptimal treatment choice. Knowing how to manage previous surgical treatment failure is also key for the treating orthopaedic surgeon, who must be able to address the root cause of failure and react accordingly and effectively. This paper analyses key factors in treatment choice, the current stance of the literature on varying degrees of bone loss and choices on surgical treatment failure, lack of evidence and need for future research.

  • shoulder
  • instability
  • bone
  • arthroscopy
View Full Text

Statistics from


  • Contributors DTTL and ACCC: wrote the section on minor bone loss. JC: wrote the section on major bone loss. NR: wrote the section on how to handle surgical failure. MP: wrote the remaining sections (abstract, introduction, discussion, current concepts and future perspectives) and finalised editing of the final version of the manuscript as per corrections made by senior GDG and EI.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.