Anterior traumatic instability with glenoid bone loss

The algorithm of treatment depends on many factors, but the size and type (fragment or erosion) of the glenoid bone deficit is the priority. If a mobile bone fragment is associated with a labral lesion, then there is a possibility to perform an arthroscopic repair, despite the size of the fragment. If there is a bone loss, there are no guidelines. If the bone deficit is greater than 20 % with respect to the healthy contralateral glenoid, a bone grafting procedure open or arthroscopic is recommended by most authors to fill the defect and to reconstruct the anatomic glenoid arch [1–4]. If the missing area of the glenoid is less than 10 % and there are no soft tissue alterations, an arthroscopic reconstruction of soft tissue is certainly a viable treatment option to restore the stability of the joint. If the bone loss is between 10 % and 20 %, other factors should be considered, such as the presence of a Hill-Sachs lesion that could represent an indication for a bone procedure (Table 36.1).