This common cause for recurrent instability can be manifested by an avulsion type bony Bankart lesion or a true fracture of the anterior or inferior glenoid rim. Standard.
Antero-posterior x-ray images may show a fracture or a more subtle loss of contour of the Antero-inferior glenoid rim. A decrease in the apparent density of the inferior glenoid line often signifies an erosion of the glenoid rim between 3 and 6 o’clock. An axillary or Bernageau view may show flattening of this area of the glenoid when bone loss has occurred.
Computed tomography (CT) provides a more detailed image, which is essential to be able to quantify the bone loss preoperatively.1 CT reconstructions provide a more robust static measurement than those afforded by the arthroscopic view. To evaluate glenoid bone loss arthroscopically, the distance from the glenoid rim to the bare spot can be measured. This can assist the surgeon in identifying an inverted pear glenoid, confirming substantial bone loss and the likely failure of an isolated soft-tissue repair.2 Even when the bony fragment is present, replacing it is not always sufficient to restore the bony glenoid articular arc, especially where recurrent episodes of instability have further eroded the remaining glenoid edge.3 There are also issues regarding healing in this potentially necrotic bone.4 In these cases, a bony reconstruction should be considered.