Glenoidmangel

Glenoidmangel, or glenoid deficiency, refers to a reduction or loss of bone in the glenoid fossa of the scapula that forms the socket part of the shoulder joint. It can be congenital (glenoid hypoplasia or dysplasia) or acquired, most commonly as a result of recurrent shoulder dislocations that remove bone from the glenoid rim. The deficiency diminishes the articular surface and contributes to instability, especially when combined with associated cartilage or labral injuries.

Pathophysiology and implications include the loss of passive stabilizing structures in front of the shoulder and an increased risk of recurrent dislocations. The amount of glenoid bone loss influences treatment choices. A widely used concept is the glenoid track, which helps predict whether a Hill-Sachs lesion (impaction fracture of the humeral head) engages the glenoid. In general, bone loss exceeding roughly 20–25% of the glenoid width is considered critical and reduces the success of soft-tissue stabilization alone, often necessitating a bony reconstruction.

Diagnosis is typically made with imaging. CT with 3D reconstruction provides precise assessment of glenoid bone loss and defect size, while MRI can evaluate soft-tissue injuries. Reports often quantify the percentage of width loss and assess concomitant injuries such as bone defects on the humeral head.

Management ranges from nonoperative treatment for minimal defects and low-demand patients to surgical reconstruction for significant bone loss. Bony procedures include the Latarjet coracoid transfer and Eden-Hybinette procedures using iliac crest grafts, with newer graft options and allografts. The choice depends on defect size, patient activity, and surgeon experience. Rehabilitation and monitoring for graft incorporation are essential.