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entitled “Glenoid Rim Fracture in Contact Athletes With Absorbable Suture Anchor Reconstruction” in the May 2009 issue of Arthroscopy. They very eloquently describe 3 patients who sustained a glenoid rim fracture caused by cysts that had developed around absorbable implants. Theoretically, however, as the authors point out, development of a cyst or any loss of bone could cause weakness in the glenoid, predisposing toward fracture if the stress is great enough. We have also seen this at our institution, and the cause of the fracture of the glenoid rim may not be associated only with the development of a cyst surrounding the implant.
The teaching over the past several years has been to move the insertion site of the arthroscopic anchor from the medial edge of the glenoid to the edge of the articular surface. To bring the capsule and labrum back onto the edge of the glenoid in an attempt to re-create the normal anatomic bumper, we have been drilling through the anterior edge of the glenoid. Theoretically, simply drilling several holes in line across the anterior glenoid would predispose the edge of the glenoid to fracture if enough stress is applied. Figure 1, Figure 2, Figure 3 show images from a patient with metallic anchors who sustained a glenoid rim fracture after a redislocation while skiing after a successful arthroscopic stabilization. We were able to reconstruct this patient's glenoid with a Latarjet procedure, and he remains in stable condition.
Figure 1Axial computed tomography scan showing fracture of glenoid rim distal to a well-fixed anchor in a patient who had a shoulder dislocation while skiing after prior successful arthroscopic stabilization.
Figure 3Three-dimensional computed tomography scan of glenoid with metallic enhancement technique. The fracture was observed between the middle and inferior anchors at the level of the drill holes for the 2 anchors.
I think it would be reasonable to assume that in addition to the theoretic weakness associated with cyst formation in the glenoid, the simple act of drilling several holes in line on the anterior edge of the glenoid would alone predispose the glenoid to fracture if enough stress is applied, as was shown in the patient we recently treated.
Reference
Banerjee S.
Weiser L.
Connell D.
Wallace A.
Glenoid rim fracture in contact athletes with absorbable suture anchor reconstruction.
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