A Clinical Comparison of Linear-

and Surface Area–Based Methods

of Measuring Glenoid Bone Loss
Neil K. Bakshi,*y MD, George A. Cibulas,y MD, Jon K. Sekiya,y MD, and Asheesh Bedi,y MD
Investigation performed at the University of Michigan, Ann Arbor, Michigan, USA

Background: The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid
bone loss in comparison with surface area–based measurement in patients with recurrent anterior shoulder instability and glenoid
bone loss.
Hypothesis: Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area–based
measurement in patients with anterior shoulder instability and glenoid bone loss.
Study Design: Cohort study (diagnosis); Level of evidence, 3.
Methods: Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT)
scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of
the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical anal-
ysis was performed with a paired 2-tailed t test.
Results: Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study;
17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage
glenoid bone loss calculated with the surface area and linear methods was 12.8% 6 8.0% and 17.5% 6 9.7% (P \ .0001),
respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and
linear methods was 16.6% 6 7.9% and 23.0% 6 8.0% (P \ .0001), respectively.
Conclusion: Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area mea-
surement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used inter-
changeably and cannot be used with the same critical thresholds for glenoid bone loss.
Keywords: shoulder instability; glenoid bone loss; surface area; linear measurement

Anterior shoulder dislocation is a common occurrence, espe-
cially among young and highly active populations. Humeral
head and glenoid bone defects are common in recurrent
shoulder instability with a prevalence ranging from 20%
to 100%, as reported by numerous studies.3,8,10-12,17,20-26
These bone deficiencies predispose a patient to further
recurrence and can result in a high rate of failure of isolated
capsulolabral repair if bony defects are large.8 Cadaveric
and clinical studies have shown that as the amount of
*Address correspondence to Neil K. Bakshi, MD, MedSport, Depart-
ment of Orthopaedic Surgery, University of Michigan, 4008 Ave Maria
Drive, A-1000, Ann Arbor, MI 48105 (email: neilbaks@med.umich.edu).
y
MedSport, Department of Orthopaedic Surgery, University of Michi-
gan, Ann Arbor, Michigan, USA.
One or more of the authors has declared the following potential con-
flict of interest or source of funding: A.B. has received consulting fees
from Arthrex, Smith & Nephew, and Stryker and has received royalties
from Smith & Nephew. J.K.S. has received royalties from Arthrex.
The American Journal of Sports Medicine
1–6
DOI: 10.1177/0363546518783724
Ó 2018 The Author(s)
glenoid bone loss approaches 15% to 20% of the anterior gle-
noid surface, a glenoid bony augmentation procedure,
rather than an isolated soft tissue repair, should be strongly
considered to reduce failure rates.8,15,18,19 As a result, accu-
rate quantification of glenoid bony defects is critical to the
successful evaluation and preoperative planning for
patients with recurrent glenohumeral instability and gle-
noid bone loss.
Multiple imaging modalities have been used in the quan-
tification of glenoid bone loss, including radiography, 2- and
3-dimensional computed tomography (3D-CT), and magnetic
resonance imaging (MRI).3,7 Recently, 3D-CT has been con-
sidered the gold standard modality for the quantification of
glenoid bone loss, when compared with these other methods.7
Furthermore, multiple methods of measurement have been
proposed in the quantification of glenoid bone loss. The
majority of these methods are based on the geometric similar-
ity between the inferior glenoid and a true circle.13 Linear-
based methods of measurement typically measure the width
of the glenoid defect, which is then divided by the diameter of
the best-fit circle, resulting in a percentage defect size.19
These methods are advantageous since they are convenient

1
2 Bakshi et al
and can be quickly applied using standard radiographic soft-
ware. Surface area–based methods measure the area of the
glenoid bony defect, which is then divided by the area of
the glenoid best-fit circle, resulting in a percentage defect
size.4,24
Recently, Bhatia et al6 questioned the validity and accu-
racy of linear-based methods of measuring glenoid bone
loss. This study mathematically/theoretically demon-
strated that glenoid diameter–based methods overestimate
bone loss, with the maximum measurement error at 20%
glenoid bone loss. Given that 20% glenoid bone loss is
a common clinical threshold for open glenoid augmenta-
tion, this overestimation of bone loss may be clinically rel-
evant and may overestimate the need for Latarjet or other
bony augmentation procedures. However, no studies have
clinically demonstrated that linear-based methods signifi-
cantly overestimate glenoid bone loss measurements. As
a result, the hypothesis of this study is that linear-based
measurement significantly overestimates glenoid bone
loss in comparison with surface area–based measurement
in patients with recurrent anterior shoulder instability
and glenoid bone loss.
METHODS
Internal review board approval was obtained for this retro-
spective study. During the study period from July 2010 to
April 2012, 30 consecutive patients (25 male and 5 female;
mean age, 24.9 years; age range, 15-58 years) were located
and evaluated for this study, of whom 28 met our inclusion
and exclusion criteria. The inclusion criteria were physical
examination findings positive for anterior shoulder instabil-
ity, the availability of preoperative bilateral shoulder CT
scans showing glenoid bone loss on the affected side, and
an age of 12 years or older. Patients with bilateral or poste-
rior shoulder instability on physical examination, patients
with bilateral or posterior glenoid bone loss on CT scan,
patients with existing hardware in the glenohumeral joint
that precluded accurate glenoid bone loss quantification,
and pregnant women were excluded from the study. Women
with childbearing potential were offered pregnancy tests
before CT scans to confirm pregnancy status.
All included patients underwent preoperative bilateral
shoulder CT scans with thin, 3-mm axial cuts being
made through the humeral head and glenoid (mean radia-
tion, 1,190.4 mGy-cm). CT examination was performed 1 to
3 months before surgical intervention to determine the
most appropriate procedure for each patient. The subse-
quent surgical procedure underwent by each patient was
documented to determine whether glenoid augmentation
(Latarjet, osteoallograft transplantation) was performed.
Bilateral shoulder CT scans were obtained as part of stan-
dard practice to use the normal glenoid as a reference point
for quantification of bone loss and to assess for bone loss on
the normal side. The 3D-CT reconstruction was performed
for each patient using MIMICS and 3-MATIC (MIMICS
Innovation Suite, version 13.1; Materialize). Subsequently,
humeral head subtraction was performed to obtain an en
face view of the 3D-CT glenoid (Figure 1).
The American Journal of Sports Medicine
Two orthopaedic surgery residents then measured the
glenoid bone loss of each patient using the Pico method (sur-
face area based) and the anterior-posterior (AP) distance
from the bare area/center method (linear based). Informa-
tion regarding the location of the glenoid bone loss (anterior
vs anterior-inferior) was also documented at the time of 3D-
CT analysis. Anterior-inferior bone loss was defined as
a bony defect where .80% of the defect was located in the
anterior-inferior quadrant of the best-fit circle. With the
Pico method, a best-fit circle is drawn on the inferior portion
of the uninjured, contralateral glenoid and is superimposed
onto the injured side. The best-fit circle was drawn to
include the entire face of the inferior glenoid. The area of
the bony defect (the area missing from the circle) is then
divided by the area of the best-fit circle (area of circle =
p*[radius]2) to estimate the percentage bone loss (Figure 2).
The AP distance from the bare area method uses the
center of the inferior glenoid circle as its primary landmark
for measurement. The distances from the center of the infe-
rior glenoid circle to the anterior edge (A) and to the poste-
rior edge (B) are measured, and bone loss is determined
with the following formula: (B – A)/2B 3 100%. These
measurements are made at the equator of the best-fit cir-
cle.19 The percentage bone loss values measured by each
observer were averaged, resulting in a mean percentage
bone loss for each patient with each method (Figure 3).
Subsequently, we repeated the linear method measure-
ment using the normal, contralateral glenoid as our refer-
ence for bone loss quantification. The mean percentage
bone loss obtained by each method was compared to deter-
mine any differences between linear- and surface area–
based methods of measurement.
Statistical Analysis
An a priori power analysis (power = .8, P \ .05) was per-
formed and demonstrated the need for at least 28 patients.
Interobserver agreement was calculated for both methods to
evaluate for consistency between users. Statistical analysis
was performed with a paired 2-tailed t test to determine
whether there is a statistically significant difference
between surface area– and linear-based methods of measur-
ing glenoid bone loss. Statistical significance was set at an
alpha level of .05, with Bonferroni correction.
RESULTS
Of the 30 patients, 2 were excluded from the study due to
existing hardware in the glenohumeral joint that precluded
accurate measurement of glenoid bone loss. Of the remain-
ing 28 patients (5 female and 23 male; mean age, 25.1 years;
age range, 15-58 years), 17 underwent a glenoid augmenta-
tion procedure (Latarjet, osteoallograft reconstruction) and
11 underwent arthroscopic Bankart repair. Overall, 20 of
the 28 patients were found to have anterior glenoid bone
loss, while the other 8 patients were found to have primarily
anterior-inferior glenoid bone loss.
For all 28 patients, the mean percentage glenoid bone
loss calculated with the Pico method (surface area–based
AJSM Vol. XX, No. X, XXXX Glenoid Bone Loss: Linear vs Area 3

Figure 1. (A) Three-dimensional computed tomography (3D-CT) reconstruction of the normal glenoid. (B) 3D-CT reconstruction
of the affected glenoid with an anterior bony defect.

Figure 2. Representation of the surface area–based method of measuring glenoid bone loss (Pico method). An en face three-
dimensional computed tomography view of the normal glenoid is obtained. (A) A best-fit circle is applied to the inferior two-thirds
of the normal glenoid. (B) This best-fit circle is then superimposed on the affected contralateral glenoid. Glenoid bone loss is cal-
culated with the indicated equation.

method using the contralateral glenoid) was 12.8% 6 8.0%
(interobserver agreement, .969). The mean percentage gle-
noid bone loss calculated with the AP distance from bare
area method (linear based) was 17.5% 6 9.7% (interob-
server agreement, .953). Using the contralateral best-fit
circle, the AP distance from bare area method resulted in
an average glenoid bone loss of 17.9% 6 8.4% (interob-
server agreement, .979). The difference between the Pico
method and the AP distance from bare area method was
statistically significant with P \ .0001. Of the 28 patients,
15 patients (54%) had greater than 5% overestimation with
the linear method compared with the surface area method;
5 patients (18%) had greater than 10% overestimation with
the linear method compared with the surface area method.
In the 20 patients found to have anterior glenoid bone
loss, the mean percentage bone loss calculated with the
Pico method was 13.7% 6 6.3%. The mean percentage
bone loss calculated with the AP distance from bare area
method was 20.3% 6 8.3%, with the difference between
these methods being statistically significant (P \ .0001).
In the 8 patients with anterior-inferior glenoid bone
loss, the mean percentage bone loss calculated with the
Pico method was 10.8% 6 10.7%. The mean percentage
bone loss calculated with the AP distance from bare area
method was 10.6% 6 10.0% (P = .8222).
Sixteen patients were found to have linear bone loss
measurements between 15% and 25%, which is in the
threshold range commonly used to indicate bony glenoid
augmentation.5 In these 16 patients, the mean percentage
bone loss calculated with the linear (AP distance from bare
area) method was 23.1% 6 6.3%. The mean percentage
bone loss calculated with the surface area (Pico) method
was 15.3% 6 6.0%, with the difference between these
methods being statistically significant (P \ .0001). The
overestimation of the linear method compared with the
surface area method was the largest within this 15% to
25% glenoid bone loss range.
For the patients who underwent glenoid augmentation,
mean percentage bone loss with the linear and surface
area methods was 23.0% 6 8.0% and 16.6% 6 7.9% (P \
.0001), respectively. Of the 17 patients who underwent
a subsequent glenoid augmentation procedure, 14 patients
had greater than 5% overestimation of glenoid bone loss
with the linear method compared with the surface area
4 Bakshi et al
Figure 3. Representation of the linear-based method of
measuring glenoid bone loss (anterior-posterior distance
from bare area method). An en face three-dimensional com-
puted tomography view of the affected glenoid is obtained. A
best-fit circle is applied to the inferior two-thirds of the gle-
noid, with a point drawn at the center of the circle. The dis-
tance from the center of the circle to the anterior rim (A)
and posterior rim (B) is measured, and bone loss is calcu-
lated with the given equation.
method. Of these 17 patients who underwent glenoid aug-
mentation, 8 patients (47%) had a surface area–based cal-
culation of glenoid bone loss that was less than 15%; 12 of
the 17 patients (71%) had a surface area–based calculation
of glenoid bone loss that was less than 20%.
DISCUSSION
The results of the current study confirm our hypothesis
that linear measurements of glenoid bone loss significantly
overestimate bone loss compared with surface area bone
loss measurements (linear, 17.5% 6 9.7%; surface area,
12.8% 6 8.0%; P \ .0001). Furthermore, the linear overes-
timation of glenoid bone loss occurred primarily with ante-
rior glenoid bony defects and not anterior-inferior glenoid
bone loss. In addition, for patients who underwent a bony
glenoid augmentation, there was a significant difference
between linear (23.0% 6 8.0%) and surface area (16.6% 6
7.9%) glenoid bone loss measurements (P \ .0001). Further-
more, 47% of patients (8/17) who underwent glenoid aug-
mentation had surface area measurements of glenoid bone
loss that were less than 15%, suggesting the alternative
potential for successful treatment with an isolated soft tis-
sue procedure if measured by this alternative technique.5
The significant overestimation of glenoid bone loss with
linear methods is likely due to the geometric difference
between the inferior glenoid circle and a square.6 A linear
The American Journal of Sports Medicine
(diameter)–based scheme incorrectly assumes that the geo-
metric area calculation of a circular segment is analogous to
an area calculation of a segment of a square. For a square,
calculating the percentage area of a segment (relative to the
total area of the square) can easily be performed by dividing
the width of the segment by the total length of the square.
Unfortunately, when this model is applied to a true circle,
significant overestimation occurs because of the geometric
differences between these shapes.6
When stratified by location of bone loss, our results indi-
cate that linear methods of measuring glenoid bone loss typ-
ically only overestimate anterior bony defects. Measurements
of anterior-inferior glenoid bony defects were consistent with
surface area measurements of bone loss. This is likely related
to linear (diameter) measurements being performed at the
center/equator of the inferior glenoid circle. For anterior gle-
noid bone loss, measurement at the equator of the circle
accounts for the main part of the glenoid bony defect, often
measuring at the widest part of the defect. However, for
anterior-inferior glenoid bone loss, measurement at the equa-
tor of the circle accounts for the superior aspect of the defect,
often measuring at a narrower part of the glenoid bony
defect. Therefore, for patients with anterior-inferior bony
defects, quantification at the superior aspect of the defect
results in smaller glenoid bone loss measurements since
the widest, and perhaps more clinically significant, parts of
the defect are not being measured. This demonstrates the
variability of linear-based measurement of glenoid bone
loss, as it can often miss the most clinically significant por-
tions of the bony defect.
The overestimation of glenoid bone loss by linear mea-
surement calls into question its accuracy and validity for
clinical decision making. Overestimation of glenoid bone
loss for patients with recurrent anterior shoulder instabil-
ity may result in stronger indication for an open glenoid
augmentation procedure when an isolated soft tissue
repair (capsulolabral repair) may be sufficient. While
both procedures may be clinically effective in stabilizing
the glenohumeral joint with favorable patient-reported
outcomes, a more accurate estimation of size may allow
for more informed decision making that is appropriately
guided by patient and surgeon preferences. Although not
definitive evidence, a need for more accurate measurement
is suggested by our results, as there was a significant dis-
crepancy between linear (23.0% 6 8.0%) and surface area
(16.6% 6 7.9%) measurements (P \ .0001) of glenoid
bone loss for those who underwent glenoid augmentation.
Furthermore, 8 of the 17 patients who underwent glenoid
augmentation had surface area measurements that were
less than 15%, with 12 of 17 patients having surface area
measurements less than 20%. This difference is clinically
significant when considering that 20% glenoid bone loss
is a common threshold used by clinicians to necessitate
open glenoid augmentation.5,19 If accurate measurement
of glenoid bone loss had been performed for this cohort, it
is possible that some or many of these patients could
have successfully undergone an arthroscopic Bankart
repair. The use of linear measurement of glenoid bone
loss for clinical decision making is also questioned, given
that its overestimation error is greatest between 15% and
AJSM Vol. XX, No. X, XXXX
25% bone loss.6 Accurate glenoid bone loss measurement is
arguably most important in this 15% to 25% range, as this
is the gray zone in which both arthroscopic Bankart repair
with or without remplissage and glenoid augmentation will
commonly be performed.
These results also demonstrate the need for biomechan-
ical studies that define the threshold percentage of glenoid
bone loss by linear and surface area methods that result in
a significant risk of recurrent glenohumeral instability
without bony augmentation of the glenoid. Furthermore,
these results demonstrate that the method used to derive
the percentage thresholds for bone loss should be the
same method used clinically for bone loss measurement.
Itoi et al14 and Yamamoto et al27 in a cadaver model exam-
ined glenoid bone loss with sequential osteotomies and
found 21% and 20% bone loss, respectively, to be the criti-
cal threshold at which glenoid augmentation would be nec-
essary. However, these measurements were neither
diameter (glenoid width) based nor surface area based
and have limited clinical utility as a result. These studies
performed cadaveric osteotomies at a 45° angle to the lon-
gitudinal axis of the glenoid, from the 3-o’clock to 6-o’clock
position. Glenoid bone loss was determined by measuring
the width of this osteotomy in the 45° orientation (perpen-
dicular to the osteotomy). This width is subsequently
divided by the glenoid length measured in the superior-
inferior direction multiplied by 100%, resulting in the per-
centage glenoid bone loss. These studies did not use the AP
distance from bare area method (linear) or the circle/Pico
methods (surface area) that are commonly used to measure
glenoid bone loss. As a result, the thresholds that were
established by these cadaveric studies cannot be applied
to the linear and surface area methods that are dis-
cussed/used currently. Furthermore, other studies have
attempted to quantify glenoid bone loss arthroscopically
using the bare spot method.8,9,15 However, this is limited
by the eccentric location of the bare spot and its tendency
to overestimate glenoid bone loss as a result.1,3 Therefore,
the critical thresholds established by the above studies
(cadaveric and arthroscopic) cannot be applied to linear-
and surface area–based measurements on 3D-CT, since
the thresholds were established with different methods.
As a result, 20% bone loss in the above studies is not equiv-
alent to 20% bone loss with linear or surface area methods.
Furthermore, 20% bone loss cannot generically be accepted
as the threshold for bony augmentation, regardless of mea-
surement method. Since these methods cannot be used
interchangeably, this also suggests the importance of
clearly stating the technique of glenoid bone loss measure-
ment used when evaluating patients clinically.
This is the first study using patient data to demonstrate
a statistically significant difference between linear- and
surface area–based measurement of glenoid bone loss.
Bhatia et al6 reported overestimation of anterior glenoid
bone loss by diameter-based measurement compared with
surface area–based measurement and provided geometric
rationale for this overestimation. However, they demon-
strated this mathematically and without the use of any
clinical/patient data. Furthermore, they did not examine
any differences in measurement between anterior and
Glenoid Bone Loss: Linear vs Area 5
anterior-inferior glenoid bone loss. Altan et al2 compared
glenoid bone loss quantification with surface area and lin-
ear measurements in 36 patients and demonstrated
a near-perfect correlation between these measurements
when bone loss was less than 6%. They reported that the
difference between surface area and linear measurements
was increased when bone loss was greater than 14% but
did not show any statistically significant differences. Fur-
thermore, they did not stratify based on the location of
the glenoid bone loss and did not report on the clinical sig-
nificance of the values.
Limitations
Our study had multiple limitations. First, we had a rela-
tively small sample size of 28 patients who were included
in the study. Although this sample is limited, the power
analysis did demonstrate that our study was adequately
powered and has unique access to bilateral CT scans for
true quantification of surface area of glenoid bone loss.
Finally, there is some user error and variability involved
with the linear- and surface area–based measurements of
glenoid bone loss. However, concerns regarding this vari-
ability were mitigated by our interobserver reliability dem-
onstrating almost perfect agreement.16
CONCLUSION
Linear measurement of glenoid bone loss significantly
overestimates bone loss compared with surface area mea-
surement in patients with predominantly anterior glenoid
bony defects. This discrepancy suggests the need for fur-
ther biomechanical research to establish the critical
thresholds of bone loss for the surface area and linear
methods. These results indicate that these different meth-
ods cannot be used interchangeably and cannot be used
with the same critical thresholds for glenoid bone loss.
REFERENCES
1. Aigner F, Longato S, Fritsch H, Kralinger F. Anatomical considera-
tions regarding the ‘‘bare spot’’ of the glenoid cavity. Surg Radiol
Anat. 2004;26:308-311.
2. Altan E, Ozbaydar MU, Tonbul M, Yalcin L. Comparison of two differ-
ent measurement methods to determine glenoid bone defects: area
or width? J Shoulder Elbow Surg. 2014;23:1215-1222.
3. Bakshi NK, Patel I, Jacobson JA, Debski RE, Sekiya JK. Comparison
of 3-dimensional computed tomography-based measurement of gle-
noid bone loss with arthroscopic defect size estimation in patients
with anterior shoulder instability. Arthroscopy. 2015;31(10):1880-1885.
4. Baudi P, Righi P, Bolognesi D, et al. How to identify and calculate gle-
noid bone deficit. Chir Organi Mov. 2005;90:145-152.
5. Bhatia S, Ghodadra NS, Romeo AA, et al. The importance of the rec-
ognition and treatment of glenoid bone loss in an athletic population.
Sports Health. 2011;3(5):435-440.
6. Bhatia S, Saigal A, Frank RM, et al. Glenoid diameter is an inaccurate
method for percent glenoid bone loss quantification: analysis and
techniques for improved accuracy. Arthroscopy. 2015;31(4):608-
614.e1.
7. Bishop JY, Jones GL, Rerko MA, Donaldson C; MOON Shoulder
Group. 3-D CT is the most reliable imaging modality when quantifying
glenoid bone loss. Clin Orthop Relat Res. 2013;471(4):1251-1256.
6 Bakshi et al
8. Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and
their relationship to failure of arthroscopic Bankart repairs: signifi-
cance of the inverted-pear glenoid and the humeral engaging Hill-
Sachs lesion. Arthroscopy. 2000;16:677-694.
9. Burkhart SS, De Beer JF, Tehrany AM, Parten PM. Quantifying gle-
noid bone loss arthroscopically in shoulder instability. Arthroscopy.
2002;18:488-491.
10. Calandra JJ, Baker CL, Uribe J. The incidence of Hill-Sachs lesions
in initial anterior shoulder dislocations. Arthroscopy. 1989;5:254-
257.
11. Detterline AJ, Provencher MT, Ghodadra N, Bach BR Jr, Romeo AA,
Verma NN. A new arthroscopic technique to determine anterior-
inferior glenoid bone loss: validation of the secant chord theory in
a cadaveric model. Arthroscopy. 2009;25:1249-1256.
12. Edwards TB, Boulahia A, Walch G. Radiographic analysis of bone
defects in chronic anterior shoulder instability. Arthroscopy.
2003;19:732-739.
13. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape
of the inferior part of the glenoid: a cadaveric study. J Shoulder
Elbow Surg. 2006;15:759-763.
14. 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.
15. Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: an indica-
tor of significant glenoid bone loss. Arthroscopy. 2004;20:169-174.
16. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med
(Zagreb). 2012;22(3):276-282.
17. Owens BD, Nelson BJ, Duffey ML, et al. Pathoanatomy of first-time,
traumatic, anterior glenohumeral subluxation events. J Bone Joint
Surg Am. 2010;92:1605-1611.
For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
The American Journal of Sports Medicine
18. Piasecki DP, Verma NN, Romeo AA, Levine WN, Bach BR Jr, Pro-
vencher MT. Glenoid bone deficiency in recurrent anterior shoulder
instability: diagnosis and management. J Am Acad Orthop Surg.
2009;17:482-493.
19. Provencher MT, Bhatia S, Ghodadra NS, et al. Recurrent shoulder
instability: current concepts for evaluation and management of gle-
noid bone loss. J Bone Joint Surg Am. 2010;92(suppl 2):133-151.
20. Provencher MT, Frank RM, Leclere LE, et al. The Hill Sachs lesion:
diagnosis, classification, and management. J Am Acad Orthop
Surg. 2012;20:242-252.
21. 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;33:889-893.
22. Sekiya JK, Jolly J, Debski RE. The effect of a Hill-Sachs defect on
glenohumeral translations, in situ capsular forces, and bony contact
forces. Am J Sports Med. 2012;40:388-394.
23. Skendzel JG, Sekiya JK. Diagnosis and management of humeral head
bone loss in shoulder instability. Am J Sports Med. 2012;40:2633-2644.
24. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim mor-
phology in recurrent anterior glenohumeral instability. J Bone Joint
Surg Am. 2003;85:878-884.
25. Tjoumakaris FP, Humble B, Sekiya JK. Combined glenoid and
humeral head allograft reconstruction for recurrent anterior gleno-
humeral instability. Orthopedics. 2008;31:497.
26. Tjoumakaris FP, Kropf EJ, Sekiya JK. Osteoarticular allograft recon-
struction of a large glenoid and humeral head defect in recurrent
shoulder instability. Tech Shoulder Elbow Surg. 2007;8:98-104.
27. Yamamoto N, Itoi E, Abe H, et al. Effect of an anterior glenoid defect
on anterior shoulder stability: a cadaveric study. Am J Sports Med.
2009;37:949-954.