Contact between the glenoid and the humeral head in
abduction, external rotation, and horizontal extension:
A new concept of glenoid track
Nobuyuki Yamamoto, MD,a Eiji Itoi, MD,b Hidekazu Abe, MD,a Hiroshi Minagawa, MD,a
Nobutoshi Seki, MD,a Yoichi Shimada, MD,a Kyoji Okada, MD,a Akita and Sendai, Japan
To date, no anatomic or biomechanical studies have
been conducted to clarify what size of a Hill-Sachs
lesion needs to be treated. Nine fresh-frozen cadaveric
shoulders were tested in a custom device. With the
arm in maximum external rotation, horizontal exten-
sion, and 0°, 30°, and 60° of abduction, the location
of the entire rim of the glenoid was marked on the hu-
meral head using a Kirschner wire. The distance from
the contact area to the footprint of the rotator cuff with
the arm in 60° of abduction was measured by a digi-
tal caliper. With an increase in arm elevation, the gle-
noid contact shifted from the inferomedial to the su-
perolateral portion of the posterior aspect of the
humeral head, creating a zone of contact (glenoid
track). The medial margin of the glenoid track was
located 18.4 ⫾ 2.5 mm medial from the footprint,
which was equivalent to 84% ⫾ 14% of the glenoid
width. A Hill-Sachs lesion has a risk of engagement
and dislocation if it extends medially over the medial
margin of the glenoid track. (J Shoulder Elbow Surg
2007;16:649-656.)
B ony defects of the glenoid and humeral head are
common injuries associated with anterior glenohu-
meral instability. The incidence of defects of the
glenoid ranges between 8% (18/226) and 90%
(90/100)2,9,12,15,19,28,34,35 and of the humeral
head between 38% (48/125) and 100% (60/
60)7,13,14,25,28,33 in shoulders with recurrent ante-
rior dislocation. Most of these lesions are small-to-
From the aDivision of Orthopedic Surgery, Department of Neuro
and Locomotor Science, Akita University School of Medicine;
and the bDepartment of Orthopedic Surgery, Tohoku University
School of Medicine.
Reprint requests: Eiji Itoi, MD, Department of Orthopedic Surgery,
Tohoku University School of Medicine, 1-1 Seiryo-cho, Aoba-ku,
Sendai 980-8574, Japan (E-mail: itoi-eiji@mail.tains.tohoku.
ac.jp).
Copyright © 2007 by Journal of Shoulder and Elbow Surgery
Board of Trustees.
1058-2746/2007/$32.00
doi:10.1016/j.jse.2006.12.012
moderate in size and do not appear to influence
recurrent instability.8
For a glenoid bony defect, a cadaveric study by
Itoi et al16 revealed that a defect of at least 21% of the
superior-inferior glenoid length would cause instabil-
ity after a Bankart repair without bone grafting.
Burkhart et al3,4 reported from their clinical experi-
ence that a defect greater than 25% of the glenoid
width would need bone grafting, because in such
cases, the Bankart repair alone did not yield satisfac-
tory results.
Rowe et al29 classified the Hill-Sachs lesion into 3
sizes: mild (2 cm ⫻ 0.3 cm), moderately severe (4 cm
⫻ 0.5 cm), and severe (4 cm ⫻ 1 cm or more). With
a Bankart repair alone, the recurrence rate was 0%
(0/30) in shoulders with a mild Hill-Sachs lesion,
whereas it was 4.7% (3/64) and 6.0% (1/16) in
shoulders with moderately severe and severe Hill-
Sachs lesions, respectively.28,29 From these data,
they concluded that a severe Hill-Sachs lesion was a
risk factor for recurrent dislocation after a Bankart
repair and that a procedure such as transplantation of
the infraspinatus tendon into the humeral head defect
should be considered in such cases.29
Burkhart and Debeer4 analyzed the results of 194
consecutive arthroscopic Bankart repairs and identi-
fied specific factors related to recurrence of instabil-
ity. According to their report, 1 factor was a signifi-
cant bony defect of the humeral head that engaged
with the anterior glenoid rim with the shoulder in
abduction and external rotation. Several authors have
recently recommended that a Hill-Sachs lesion greater
than 20%6 or 25%23 of the humeral head be recon-
structed using an allograft.
Hardy et al9 measured the depth and the volume of
a Hill-Sachs lesion. They reported that an arthroscopic
Bankart repair was contraindicated for shoulders with
a Hill-Sachs lesion whose depth was greater than
16% of the humeral head diameter or whose volume
exceeded 1000 mm3. These reports were all based
on their clinical experiences. To our knowledge, no
anatomic or biomechanical studies to date have clar-
ified what size Hill-Sachs lesion is critical and needs
to be treated.
649
650 Yamamoto et al J Shoulder Elbow Surg
September/October 2007

In patients with recurrent anterior dislocation, the

result of the anterior apprehension test is usually
positive at various degrees of abduction, depending
on the location of the Bankart lesion: it is positive with
lower degrees of abduction when a Bankart lesion is
located high, whereas it is positive with higher de-
grees of abduction when the lesion is located low.27
These positions are critical positions to induce an
anterior dislocation. It is important to know, therefore,
the exact anatomic relationship between the humeral
head and the glenoid in these critical positions. To the
best of our knowledge, no such studies have been
reported in the literature. The purpose of this study
was to determine the articulating surface of the hu-
meral head with the glenoid with the arm in various
degrees of abduction while it was kept in maximum
external rotation and horizontal extension.

MATERIALS AND METHODS

Preparation of specimens
We used 9 fresh-frozen cadaveric shoulders from donors
with a mean age of 71 years (range, 63-79 years) at the
time of death. The shoulders were from 6 men and 3 women
(5 left, 4 right shoulders). The exclusion criteria were those
with rotator cuff tears, fractures, contracture, osteoarthritis,
or other diseases of the shoulder detectable by direct in-
spection or on radiographs.
The previously frozen shoulders were thawed overnight
at room temperature. Each specimen was disarticulated at
the scapulothoracic joint proximally and transected at the
middle part of the humerus distal to the deltoid attachment
distally. The skin, subcutaneous tissue, and all the muscles
were removed except for the rotator cuff. The lateral one
third of the scapular spine, including the acromion and the
distal half of the coracoid process, was removed. The
supraspinatus tendon was sectioned together with the joint
capsule at its insertion to the greater tuberosity by using a
sharp blade. The infraspinatus and teres minor tendons
were also released from the greater tuberosity with the
posterior capsule.
Because opening the posterior half of the joint capsule
could affect the results of this experiment, in a pilot study,
we measured the distance from the medial margin of the
contact area to the medial margin of the footprint with the
arm at 60° of abduction in a shoulder first with the posterior
capsule and the intact infraspinatus and teres minor tendons
intact and then with the posterior capsule opened and the
infraspinatus and teres minor tendons released. The mean
(⫾ standard deviation) distance with the posterior capsule
opened and the infraspinatus and teres minor tendons
released was 20.9 ⫾ 1.3 mm compared with 19.7 ⫾ 1.5
mm for the intact specimens. The difference between them
was not significant (P ⫽ .32).
Finally, the remnant posterior capsule was vertically
sectioned down to the 6 o’clock position, leaving the pos-
terior half of the joint open. This enabled us to evaluate the
contact between articular surfaces of the humeral head and
the glenoid. All anterior soft-tissue structures were pre-
served. The subscapularis tendon was bluntly separated
Figure 1 Custom-designed shoulder-positioning device.
from the capsule so that the rim of the glenoid could be
palpated through the capsule during the marking procedure
described below.
A pair of acrylic plates (240 mm long ⫻ 40 mm wide)
was fixed to the medial border of the scapula with 4-mm
plastic screws. Another pair of acrylic plates (220 mm long
⫻ 130 mm wide) was fixed to the scapular body with
1.8-mm Kirschner wires. Cables were attached to Kirschner
wires inserted into the greater and lesser tuberosities to
apply compressive force and rotational torque to the hu-
merus. A 10-mm-diameter intramedullary rod was inserted
into the proximal humeral shaft and fixed in place with
polymethyl methacrylate.
The specimens were then attached to a custom-designed
shoulder-positioning device (Figure 1). The device allowed
the humerus to be placed in a given plane of elevation (such
as the scapular or coronal plane), a given angle of gleno-
humeral elevation (0° to 100°), a given angle of humeral
rotation (external or internal), and a given angle of horizon-
tal extension. The coronal plane was defined as that which
was 30° horizontally extended relative to the scapular
plane.17
A 22-N force37 was applied to the humeral head
against the glenoid fossa through the cables attached to the
Kirschner wires in the humeral head with pulleys and
weights to keep the humeral head centered in the glenoid
fossa during the test. A screw was inserted perpendicular to
the humeral shaft, 10° internally rotated from the plane
including the humeral axis and the bicipital groove. The
screw was used as a reference to indicate the anterior/
posterior direction of the humerus.21 Abduction angles
J Shoulder Elbow Surg Yamamoto et al 651
Volume 16, Number 5

were 0°, 30°, and 60° relative to the scapula, simulating

0°, 45°, and 90° of abduction of the arm relative to the
trunk.26 Neutral rotation was defined relative to the trunk,
which was equivalent to 30° of external rotation relative to
the scapular plane. The position of the humerus relative to
the scapula was determined using a goniometer attached
to the shoulder-positioning device. The specimen was kept
moist with a spray of saline solution applied every 5 to 10
minutes during the test, which was performed at room
temperature (24°C).

Arm positions
Three positions were chosen for testing: (1) 0° of
abduction, maximum external rotation, and extension,
(2) 30° of abduction, maximum external rotation, and
horizontal extension, and (3) 60° of abduction, maxi-
mum external rotation, and horizontal extension, simulat-
ing the one used for the anterior apprehension test.
During the test, a set of torque for external rotation and
extension was applied to the humerus with pulleys and
weights through the Kirschner wires inserted into the
greater and lesser tuberosities. In a previously reported
study39 and our pilot study, we found that a torque of
250 N-mm for external rotation, a torque of 400 N-mm
for extension, and a torque of 600 N-mm for horizontal
extension were required to make the glenohumeral joint
come to the limit of motion without causing excess tension
on the joint capsule. With these torques applied, we kept
the arm in maximum external rotation (58° ⫾ 5°), exten-
sion (20° ⫾ 5°), and horizontal extension (24° ⫾ 3°).
Marking the glenoid rim
After each arm position was set, the location of the
glenoid was marked on the humeral head by creating small
holes along the rim of the glenoid using a 1.0-mm Kirschner
wire (Figure 2). The holes were aligned 2 to 3 mm apart.
The Kirschner wire was inserted from outside the joint,
through the joint capsule and the labrum, and into the
humeral head. When we marked the anterior part of the
glenoid rim, we needed to palpate the rim using the Kirsch-
ner wire because it was not under direct vision. After
marking the location of the glenoid in all 3 test positions, the
3 sets of holes for 3 different abduction angles were painted
in 3 different colors, using acrylic color paints to distinguish
them easily.
Measurement of the distances
As shown in Figure 3, the distances from the medial
margin of the contact area to the edge of the articular
surface of the humeral head and to the medial margin of the
cuff attachment site on the greater tuberosity were mea-
sured by a digital caliper (Digital caliper PC-15JN, MITSU-
TOYO, Kawasaki, Japan). First, the articular center of the
humeral head (point C) was defined as an intersection
between a superior-inferior line connecting 12 and 6
o’clock and a lateral-medial line connecting 3 and 9
o’clock of the articular surface of the humeral head. Then,
the most medial point (point M) was determined on the
medial margin of the contact area, such that the distance
from the articular center (point C) to the most medial point
Figure 2 This photo shows marking the glenoid rim at the 8
o’clock position from the posterior view of the right specimen. The
glenoid rim was marked on the humeral head using a Kirschner
wire (arrow).
(point M) would be the shortest. Finally, the distance from
point M to the lateral margin of articular surface on a line
CM (point A) was measured. With the arm at 60° of
abduction, the line CM passed through the footprint of the
rotator cuff. Thus, the distance from point M to the medial
margin of the footprint (point F) on the line CM was also
measured in this position. After the experiments, the hu-
meral head diameter and the glenoid width without the
labrum were measured by a digital caliper. All the mea-
surements were performed by a single investigator.
The width of the labrum was not included in the mea-
surement, because we found in a preliminary study that the
anterior labrum was so stretched with the arm in abduction,
external rotation, and horizontal extension that it was im-
possible to distinguish the labrum from the capsule. To
confirm the reproducibility of our measuring method, we
repeatedly plotted the anterior rim of the glenoid with the
arm in 60° of elevation and measured the distance from the
medial margin of the contact area to the medial margin of
the footprint (MF in Figure 3) in our preliminary study. The
mean distance was 18.1 ⫾ 0.9 mm. The coefficients of
variation were calculated to be within 5%.
Contact area in live patients
To make sure that what we observed in cadaveric shoul-
ders was what was happening in live shoulders, we took
3-dimensional (3D) reconstructed CT images in 3 patients
with recurrent anterior dislocation with the arm in maximum
external rotation, horizontal extension, and at 45°, 90°,
and 135° of abduction. Each image was taken in a differ-
ent patient because of radiation exposure issues (ie, 1
position in each patient). In a 30-year-old man, the 3D CT
image was taken with the arm in maximum external rota-
tion, horizontal extension, and at 45° of abduction. In a
652 Yamamoto et al J Shoulder Elbow Surg
September/October 2007

Figure 3 The distances from the medial margin of the contact area
to the edge of the articular surface of the humeral head (MA) and
to the medial margin of the cuff attachment site on the greater
tuberosity (MF) were measured. C, Articular center of the humoral
head; M, most medial point; A, lateral margin of articular surface;
F, footprint.

28-year-old woman and 20-year-old man, it was taken with

the arm at 90° and 135° of abduction, respectively.

RESULTS
With an increase in arm elevation, the contact
area between the glenoid and the humeral head
shifted from the inferomedial to the superolateral por-
tion of the humeral head when viewed posteriorly
(Figure 4, A and B). The distance from the medial
margin of the contact area to the lateral margin of the
articular surface of the humeral head was 17.0 ⫾ 6.6
mm (0° of abduction), 16.2 ⫾ 6.2 mm (30° of ab-
duction), and 15.8 ⫾ 2.5 mm (60° of abduction) or
74% ⫾ 26% (0° of abduction), 71% ⫾ 27% (30° of
abduction), and 69% ⫾ 16% (60° of abduction) of
the glenoid width. The distance from the medial mar-
gin of the contact area to the medial margin of the
footprint was 18.4 ⫾ 2.5 mm or 84% ⫾ 14% of the
glenoid width with the arm at 60° of abduction.
The 3D CT images taken in live patients are shown
in Figure 5. These images clearly demonstrate that in
Figure 4 A, The contact area between the glenoid and the
humeral head. The contact areas at 0°, 30°, and 60°of abduction
were marked by the holes painted in acrylic paints. The contact
area shifted from the inferomedial to superolateral portion of the
posterior articular surface of the humeral head. B, This schematic
drawing of A shows the margins of the contact area at 0° (trian-
gles), 30° (squares), and 60° (circles).
live shoulders, the glenoid shifted the same way as
was observed in the cadaveric shoulders.
DISCUSSION
The contact area of the glenohumeral joint has been
reported by several investigators18,33,36; however,
these reports focused on the relationship between the
J Shoulder Elbow Surg Yamamoto et al 653
Volume 16, Number 5

Figure 5 Contact between the glenoid and the humeral head in live shoulders with anterior instability. The scapula
was removed except the articular surface of the glenoid on these 3-dimensional images reconstructed from the
computed tomography scans. The arm was in maximum external rotation and horizontal extension and was
elevated at (A) 45°, (B) 90°, and (C) 135°.

contact area and glenohumeral motion. To the best of
our knowledge, no reports have clarified the contact
area of the humeral head and the glenoid from the
viewpoint of shoulder dislocation. We focused on this
point and measured the width of the contact zone in
cadaveric shoulders with the arm in various degrees of
abduction while it was kept in maximum external rota-
tion and horizontal extension. With the arm in these
extreme positions, we were able to examine how the
glenoid shifted on the humeral head. We demonstrated
that as the arm was elevated, the glenoid shifted from
the inferomedial to the superolateral portion of the pos-
654 Yamamoto et al J Shoulder Elbow Surg
September/October 2007

Figure 6 Glenoid track. With the elevation of the arm, the glenoid
created a zone of contact (gray zone) along the rim of the humeral
head. We defined this zone as a “glenoid track.”

terior articular surface of the humeral head, creating a

zone of contact between the glenoid and the humeral
head. We define this contact zone as a glenoid track
(Figure 6).
The width of the glenoid track from the cuff attach-
ment site of the greater tuberosity was 84% of the
glenoid width. With this concept of the glenoid track,
we are able to assess the risk of a Hill-Sachs lesion
engaging with the glenoid rim with or without a bony
defect. For example, if a Hill-Sachs lesion remains
within the glenoid track, there is no chance that the
Hill-Sachs lesion overrides the rim of the glenoid
(Figure 7, A). On the other hand, if the medial margin
of a Hill-Sachs lesion is outside of the glenoid track,
there is a risk that the humeral head overrides the
glenoid rim (Figure 7, B). Therefore, the most impor-
tant point judging whether a Hill-Sachs lesion en-
gages with the anterior glenoid rim or not is not the
length or depth but the location of the Hill-Sachs
lesion.
Similarly, the width of the glenoid track is solely
determined by the width of the glenoid. If there is a
bony defect of the anterior rim of the glenoid, the
width of the glenoid track decreases accordingly. A
bony defect of the glenoid is located at the anterior
rim of the glenoid and pointing toward 3 o’clock.31
Figure 7 Glenoid track and Hill-Sachs lesion. A, If a Hill-Sachs
lesion remains within the glenoid track, there is no chance that the
Hill-Sachs lesion overrides the rim of the glenoid. B, If the Hill-Sachs
lesion extends more medially than the glenoid track, there is a risk
that the humeral head overrides the glenoid rim.
Therefore, a defect at the anterior rim of the glenoid
directly affects the width of the glenoid track.
The glenoid bare spot can be used as a center of
the inscribed circle to quantify the percentage bone
loss of the inferior glenoid as shown in a previous
study.3 The glenoid width can easily be measured on
regular CT images, and the glenoid track width can
be calculated as glenoid width ⫻ 0.84. Figure 8, A
shows the glenoid pushing the cuff tendon close to its
attachment to bring the arm in maximum external
rotation and horizontal extension. This makes the
width of the glenoid track 84% of the glenoid width.
J Shoulder Elbow Surg
Volume 16, Number 5
Figure 8 Glenoid track and a bony defect of the glenoid. A, As
the glenoid pushes the cuff tendon at its insertion by 16% of the
glenoid width, the remnant 84% covers the articular surface of the
humeral head. B, In a case with a bony defect of the glenoid, the
defect width (a) should be subtracted from the 84% length to obtain
a true glenoid track width (b) in this shoulder.
Because the glenoid track is defined as a zone of
contact between the glenoid and the humeral head, it
totally depends on the width of the glenoid.
The width of the glenoid track decreases accordingly
if there is a glenoid defect. To obtain the true glenoid
track width in a case with a bony defect at the anterior
rim of the glenoid (Figure 8, B), the defect width should
be subtracted from 84% of the glenoid width, which is
the width of glenoid track without a glenoid defect. This
way, the bony defects of the glenoid and the humeral
head can be assessed with regard to each other. All the
Yamamoto et al 655
previously reported indications for surgical treatment of
glenoid and humeral head defects were determined
separately. Although the concept of taking both lesions
into consideration has been introduced in previous re-
ports,5,20,38 none of them has shown exactly how to
apply this concept in one’s practice. Our new concept
enables us to take both lesions into consideration when
assessing a shoulder with anterior instability.
In the present study, we measured distances from
the medial margin of the contact area to the edge of
the humeral cartilage and to the cuff attachment site.
The edge of the posterolateral articular cartilage of
the humeral head is often destroyed by the presence
of a Hill-Sachs lesion in shoulders with anterior insta-
bility,7,13,14,32 whereas the cuff attachment site on the
greater tuberosity is always intact. The latter may
therefore be a better parameter to compare the width
of the glenoid track and the width of a Hill-Sachs
lesion in the clinical setting.
One of the treatment strategies for a large Hill-
Sachs lesion is to limit external rotation by tightening
the anterior soft-tissue structures1,10,22,24,30 or per-
forming a rotational humeral osteotomy30,38 to pre-
vent engagement of the Hill-Sachs lesion with the
glenoid rim. This treatment rationale can be ex-
plained with use of the glenoid track. Tightening the
anterior soft-tissue structures limits external rotation
and horizontal extension, making the glenoid track
shift medially and superiorly. This shift covers the
entire Hill-Sachs lesion and thus prevents engagement
of the lesions.
The present study had several limitations. First, the
width of the labrum was not included for the measure-
ment. The labrum may contribute to the glenoid track
width or engagement of the glenoid with the Hill-
Sachs lesion. However, it was impossible to distin-
guish the labrum from the capsule.
Second, we used a Kirschner wire to mark the
anterior rim of the glenoid on the humeral head. This
method may or may not be as accurate as the pres-
sure film method to measure the contact area between
the 2 bones; however, measurements using pressure
film depend on the pressure between the bones. In this
study, we traced the anterior rim of the glenoid using
a Kirschner wire with the advantage that it does not
depend on the contract pressure between the bones.
Third, one may argue that opening the posterior
half of the joint capsule might have affected the
results. The posterior capsule is known to affect the
range of motion in internal rotation, but not external
rotation.11
Fourth, on the 3D CT images, we can measure the
width of the glenoid track and the width of a Hill-
Sachs lesion; however, 3D CT may not be always
available.
In conclusion, we introduced a new concept, the
glenoid track, which enabled us to simultaneously
656 Yamamoto et al
evaluate bony defects of the humeral head and the
glenoid. When there is no glenoid defect, the width of
the glenoid track is 84% of the glenoid width. When
there is a bony defect at the anterior rim of the
glenoid, the defect width should be subtracted from
the 84% length to obtain a true width of the glenoid
track. If the medial margin of a Hill-Sachs lesion is
more medial than the glenoid track, standard stabili-
zation procedures such as Bankart repair are unlikely
to restore the shoulder stability.
REFERENCES
1. Adams JC. Recurrent dislocation of the shoulder. J Bone Joint Surg
Br 1948;30:26-38.
2. Bankart ASB. Recurrent or habitual dislocation of the shoulder
joint. BMJ 1923;2:1132-3.
3. Burkhart SS, Debeer JF, Tehrany AM, Parten PM. Quantifying
glenoid bone loss arthroscopically in shoulder instability. Arthro-
scopy 2002;18:488-91.
4. Burkhart SS, Debeer JF. Traumatic glenohumeral bone defects
and their relationship to failure of arthroscopic Bankart repairs:
significance of the inverted-pear glenoid and the humeral engag-
ing Hill-Sachs lesion. Arthroscopy 2000;16:677-94.
5. Burkhart SS, Danaceau SM. Articular arc length mismatch as a
cause of failed Bankart repair. Arthroscopy 2000;16:740-4.
6. Bühler M, Gerber C. Shoulder instability related to epileptic
seizures. J Shoulder Elbow Surg 2002;11:339-44.
7. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions
in initial anterior shoulder dislocations. Arthroscopy 1989;5:
254-7.
8. Green M, Norris TR. Glenohumeral dislocation. In: Browner BD,
Jupiter JB, Levine AM, Trafton PG, editors. Skeletal trauma: frac-
tures, dislocations, ligamentous injuries. Vol. 2. Philadelphia, Pa:
W.B. Saunders Company; 1998. p. 1639-56.
9. Hardy P. Bony lesions influence on the result of the arthroscopic
treatment of gleno-humeral instability. Symposium: Shoulder insta-
bility–limits of arthroscopic surgery: bone deficiency, shrinkage,
acute instability. Presented at the 5th International Society of
Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine
Congress, March 10-14, 2003; Auckland, New Zealand.
10. Harryman DT 2nd. Common surgical approaches to the shoul-
der. Inst Course Lect 1992;41:3.
11. Harryman DT 2nd, Matsen FA 3rd, Sidles JA. Arthroscopic
management of refractory shoulder stiffness. Arthroscopy 1997;
13:133-47.
12. Henry JH, Genung JA. Natural history of glenohumeral disloca-
tion-revisited. Am J Sports Med 1982;10:135-7.
13. Hill HA, Sachs MD. The groove defect of the humeral head. A
frequency unrecognized complication of dislocations of the shoul-
der joint. Radiology 1940;35:690-700.
14. Hovelius L. Anterior dislocation of the shoulder in teen-agers and
young adults. Five-year prognosis. J Bone Joint Surg Am 1987;
69:393-9.
15. Hovelius L, Eriksson K, Fredin H, Hagberg G, Hussenius A, Lind
B, et al. Recurrences after initial dislocation of the shoulder.
Results of a prospective study of treatment. J Bone Joint Surg Am
1983;65:343-9.
16. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a
glenoid defect on anteroinferior stability of the shoulder after
Bankart repair: a cadaveric study. J Bone Joint Surg Am 2000;
82:35-46.
17. Itoi E, Morrey BF, An KN. Biomechanics of the shoulder. In:
Rockwood CA Jr, Matsen FA 3rd, Wirth MA, Lippitt SB, editors.
The shoulder. 3rd ed. Philadelphia, Pa: WB Saunders; 2004. p.
223-67.
J Shoulder Elbow Surg
September/October 2007
18. Kelkar R, Wang VM, Flatow EL, Newton PM, Ateshian GA,
Bigliani LU, et al. Glenohumeral mechanics: a study of articular
geometry, contact, and kinematics. J Shoulder Elbow Surg 2001;
10:73-84.
19. Kralinger FS, Golser K, Wischatta R, Wambacher M, Sperner G.
Predicting recurrence after primary anterior shoulder dislocation.
Am J Sports Med 2002;30:116-20.
20. Lazarus MD, Harryman DT 2nd. Open repairs for anterior insta-
bility. In: Warner JJP, Ianotti JP, Gerber C, editors. Shoulder
surgery. Philadelphia, Pa: Lippincott-Raven; 1997. p. 47-63.
21. Matsen FA 3rd, Kirby RM. Office evaluation and management of
shoulder pain. Orthop Clin North Am 1982;13:453-75.
22. Matsen FA 3rd, Titelman RM, Lippitt SB, Rockwood CA Jr, Wirth
MA. Glenohumeral instability. In: Rockwood CA Jr, Matsen FA
3rd, Wirth MA, Lippitt SB, editors. The shoulder. 3rd ed. Phila-
delphia, Pa: WB Saunders, 2004. p. 655-794.
23. Miniaci A, Hand C, Berlet G. Segmental humeral head allografts
for recurrent anterior instability of the shoulder with large Hill-
Sachs defects: a two to eight year follow-up. Paper presented at
the 9th International Congress on Surgery of the Shoulder Meet-
ing, May 2, 2004, Washington, DC.
24. Osmond-Clark H. Habitual dislocation of the shoulder: the Putti-
Platt operation. J Bone Joint Surg Br 1948;30:19-25.
25. Palmer I, Widen A. The bone block method for recurrent dislo-
cation of the shoulder joint. J Bone Joint Surg Br 1948;30:53-8.
26. Poppen NK, Walker PS. Normal and abnormal motion of the
shoulder. J Bone Joint Surg Am 1976;58:195-201.
27. Rockwood CA Jr. Part II Subluxations and dislocations about the
shoulder. In: Rockwood CA Jr, Green DP, editors. Fractures in
adults. 2nd ed. Philadelphia, Pa: JB Lippincott; 1984. p. 722-
950.
28. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a
long-term end-result study. J Bone Joint Surg Am 1978;60:1-16.
29. Rowe CR, Zarins B, Ciullo JV. Recurrent anterior dislocation of the
shoulder after surgical repair. Apparent causes of failure and
treatment. J Bone Joint Surg Am 1984;66:159-68.
30. Saha AK. Recurrent dislocation of the shoulder. Physiopathology
and operative corrections. 2nd ed. New York, NY: Thieme,
1981.
31. Saito H, Itoi E, Sugaya H, Minagawa H, Yamamoto N, Tuoheti
Y. Location of the glenoid defect in shoulders with recurrent
anterior dislocation. Am J Sports Med 2005;33:889-93.
32. Simonet WT, Cofield RH. Prognosis in anterior shoulder disloca-
tion. Am J Sports Med 1984;12:19-24.
33. Soslowsky LJ, Flatow EL, Bigliani LU, Pawluk RJ, Ateshian GA,
Mow VC. Quantitation of in situ contact areas at the glenohu-
meral joint: a biomechanical study. J Orthop Res 1992;10:524-
34.
34. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim
morphology in recurrent anterior glenohumeral instability. J Bone
Joint Surg Am 2003;85:878-84.
35. Townley CO. The capsular mechanism in recurrent dislocation of
the shoulder. J Bone Joint Surg Am 1950;32:370-80.
36. Warner JJ, Bowen MK, Deng XH, Hannafin JA, Arnoczky SP,
Warren RF. Articular contact patterns of the normal glenohumeral
joint. J Shoulder Elbow Surg 1998;7:381-8.
37. Warner JJ, Deng XH, Warren RF, Torzilli PA. Static capsuloliga-
mentous restraints to superior-inferior translation of the glenohu-
meral joint. Am J Sports Med 1992;20:675-85.
38. Weber BG, Simpson LA, Hardegger F. Rotational humeral os-
teotomy for recurrent anterior dislocation of the shoulder associ-
ated with a large Hill-Sachs lesion. J Bone Joint Surg Am 1984;
66:1443-50.
39. Yamamoto N, Itoi E, Tuoheti Y, Seki N, Abe H, Minagawa H, et al.
Effect of rotator interval closure on glenohumeral stability and motion: a
cadaveric study. J Shoulder Elbow Surg 2006;15:750-8.