Does acromion anatomy affect the risk of acromion stress fracture after reverse shoulder arthroplasty?

Sabesan, Vani J.; Lima, Diego J.L.; Rudraraju, Ravi T.; Yang, Yang; Stankard, Matthew; Sheth, Bhavya; Liou, William W.

doi:10.1053/j.sart.2020.08.002

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…A study by Shah et al 17 demonstrated that deltoid lengthening above 25 mm and a more posteriorly oriented acromion result in higher strain patterns within the scapula. Another study by Sabesan et al 16 found that smaller acromions are at higher risk of stress fracture. Other patient specific risk factors for acromial and scapular spine stress reactions identified in a large multicenter study included chronic dislocations, massive rotator cuff tear without arthritis, rotator cuff arthropathy, self-reported osteoporosis, inflammatory arthritis, female sex, and older age.…”

Section: Discussionmentioning

confidence: 97%

Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

et al. 2022

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Section: Discussionmentioning

confidence: 97%

Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

et al. 2022

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“…Together, these studies suggest that patients with fusiform, slender rod, and sshaped scapulae have a higher risk of SS fractures. Sabesan et al 37 performed a finite-element analysis using the Delft shoulder model 38 (based on anatomical measurements of a 57-year-old male muscular cadaver) and simulated RSA implantation (Exactech Equinoxe) in scapulae with varying acromial lateralization (25, 22.5, 0, 12.5, and 15 mm) relative to the baseline scapula of the Delft model, which has a 31.9mm long acromion. The authors found that a more lateralized acromion relative to the glenoid was associated with a greater acromial fatigue life (i.e., the time spent under stress until fracture, with 12.5 mm having the highest value) and lower minimum principal stress (i.e., the stress at the most highly loaded region on the acromion during compressive cyclic loading, with 12.5 mm having the lowest value).…”

Section: Native Bony Morphologymentioning

confidence: 99%

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Buchanan,

Bindi,

Caban-Klepac

et al. 2023

JBJS Reviews

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» Biomechanical studies report that thin scapular spine (SS) morphology, superiorly placed glenoid components, and increased glenoid baseplate screws contribute to increased acromial and SS strain and may increase fracture risk. » Clinical risk factors of acromial and SS fractures after reverse shoulder arthroplasty include increasing age, female sex, osteoporosis, rheumatoid arthritis, thin midsubstance acromion morphology, previous acromioplasty, and surgical indication of cuff tear arthropathy. » Clinical studies show that, in isolation, excessive humeral lengthening, humeral lateralization, and glenoid medialization may increase risk of acromial and SS fractures. » Biomechanical studies suggest that a combination of glenoid medialization and humeral lateralization (MG/LH) may reduce fracture risk, although this requires clinical correlation. » Surgeons might reduce fracture risk in patients of high-risk groups by guarding against excessively lengthening the humerus, using a MG/LH prosthesis, and targeting screws to avoid the scapular notch and base of the SS. Level of Evidence: Level V. Narrative Review. See Instructions for Authors for a complete description of levels of evidence.

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“…This approach provides a basis for muscle and joint force prediction, as well as bone and implant deformation. Multi-body modeling has been used to assess the performances of different implant designs and surgical techniques in RTSA, with the capability to take into account accurate and physiologically meaningful boundary conditions [28,[48][49][50][51]. A multi-body modeling framework used to investigate joint stability after RTSA [28], including a rigid body model to simulate muscle and joint loading at the shoulder (A), and a FE model to calculate internal stresses and strains at the bone and implant (B).…”

Section: Computational Modeling Techniquesmentioning

confidence: 99%

“…Another multi-body modeling study simulated deltoid and rotator cuff muscle loading to investigate the effect of acromion size on the risk of acromial fracture after RTSA (Figure 7) [51]. It was found that small acromion sizes were associated with higher stresses and therefore a higher risk of acromial fracture.…”

Section: Acromial and Scapular Spine Fracturesmentioning

confidence: 99%

Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective

Huang

Ernstbrunner

Robinson

et al. 2021

JCM

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Reverse total shoulder arthroplasty (RTSA) is an established treatment for elderly patients with irreparable rotator cuff tears, complex proximal humerus fractures, and revision arthroplasty; however, with the increasing indications for RTSA over the last decade and younger implant recipients, post-operative complications have become more frequent, which has driven advances in computational modeling and simulation of reverse shoulder biomechanics. The objective of this study was to provide a review of previously published studies that employed computational modeling to investigate complications associated with RTSA. Models and applications were reviewed and categorized into four possible complications that included scapular notching, component loosening, glenohumeral joint instability, and acromial and scapular spine fracture, all of which remain a common cause of significant functional impairment and revision surgery. The computational shoulder modeling studies reviewed were primarily used to investigate the effects of implant design, intraoperative component placement, and surgical technique on postoperative shoulder biomechanics after RTSA, with the findings ultimately used to elucidate and mitigate complications. The most significant challenge associated with the development of computational models is in the encapsulation of patient-specific anatomy and surgical planning. The findings of this review provide a basis for future direction in computational modeling of the reverse shoulder.

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Does acromion anatomy affect the risk of acromion stress fracture after reverse shoulder arthroplasty?

Cited by 7 publications

References 21 publications

Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

Effect of glenosphere lateralization with and without coracoacromial ligament transection on acromial and scapular spine strain in reverse shoulder arthroplasty

Mitigating Fracture of the Acromion and Scapular Spine After Reverse Shoulder Arthroplasty

Complications of Reverse Total Shoulder Arthroplasty: A Computational Modelling Perspective

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