Treatment of Bone Defects in Posterior Instability

When compared with anterior glenohumeral instability, posterior glenohumeral instability is a relatively rare condition, and it can pose a diagnostic and therapeutic challenge for the orthopaedic surgeon. Although many patients only have damage to the posterior capsulolabral structures, some have bone defects associated with posterior instability, including defects of the posterior glenoid rim, glenoid retroversion, and an anterosuperior impaction fracture of the humeral head known as the reverse Hill-Sachs lesion. When nonoperative treatments fail, surgical management aims to identify and address both soft tissue and bony factors involved in posterior instability so as to minimize the chances of recurrent instability after surgery. Operative treatment options vary for these different bone defects associated with posterior instability, and there are relatively little data to guide surgical indications and treatment decisions. In this article, we discuss our approach to the treatment of bone defects in posterior instability with emphasis on which techniques are used in different circumstances as well as technical pearls and pitfalls.