Glenoid bone loss decreases the articulating surface of the glenohumeral joint (GHJ) and is a well-recognized cause of recurrent shoulder instability.1, 2, 3 With every subsequent dislocation, the rate of developing or worsening a glenoid or humeral head defect increases.4 Therefore, operative management is indicated in patients with substantial glenoid deficiency to prevent recurrence and further structural damage.5, 6, 7, 8, 9

Surgical management of glenoid deficiency depends on the degree of bone loss. Critical bone loss requiring a procedure is currently defined as a 20%-25% loss of the bony glenoid.10 However, more recent literature suggests surgical consideration for subcritical bone loss as low as 13.5% due to the predictive clinical decline and worsening functional outcomes, particularly in highly active individuals.8 The Instability Severity Index (ISI) Score is an additional tool to predict recurrent instability based on 6 preoperative risk factors for failure following an arthroscopic Bankart procedure. This 10-point scoring system takes into account age, activity demands, ligamentous laxity, and bone loss.11 Bony augmentation should be considered in patients with critical bone loss or an ISI score greater than 6, as these patients are prone to poorer outcomes and high failure rates following soft tissue stabilization alone.8,12, 13, 14, 15