Freehand versus navigated glenoid anchor positioning in anterior labral repair

Koulalis, Dimitrios; Kendoff, Daniel; Citak, Mustafa; O’Loughlin, Padhraig F.; Pearle, Andrew D.

doi:10.1007/s00167-010-1360-5

Cited by 9 publications

(8 citation statements)

References 20 publications

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“…The maximum deviation from the target angle was 11.9° during freehand anchor placement and 8.4° during computer-navigated anchor placement. 7 These findings indicate that knowledge of the optimum angle that maximizes the margin of error is very relevant.…”

Section: Discussionmentioning

confidence: 95%

Glenoid Rim Anatomy

Levy

Williamson²,

Flores‐Hernandez

et al. 2014

Orthopaedic Journal of Sports Medicine

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Background:Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes.Purpose:To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation.Study Design:Descriptive laboratory study.Methods:Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face.Results:Progressing in the clockwise direction, beginning at the 12:00 position, the safe insertion ranges (mean ± SD ) were 55.9° ± 10.6°, 63.6° ± 17.6°, 47.7° ± 9.1°, 46.1° ± 8°, 73.9° ± 9.7°, 40.9° ± 6.5°, 40.4° ± 7.4°, and 39.9° ± 7.1°, respectively. The optimal insertion angles were 47.9° ± 7.6°, 53.1° ± 10.9°, 35.0° ± 4.4°, 42.4° ± 4.9°, 60.9° ± 8.4°, 36.6° ± 5.9°, 31.2° ± 4.9°, 34.8° ± 4.6°, respectively.Conclusion:Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face. The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid. A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.Clinical Relevance:Proper arthroscopic technique resulting in anchor insertion at the correct angle, depth, and location will prevent anchor-related glenohumeral complications such as glenoid perforation, cartilage damage, persistent pain, decreased range of motion, and failure of the reconstruction.

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Section: Discussionmentioning

confidence: 95%

Glenoid Rim Anatomy

Levy

Williamson²,

Flores‐Hernandez

et al. 2014

Orthopaedic Journal of Sports Medicine

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“…Precise anchor placement is challenging. Koulalis et al 12 found that the use of a navigation system provided no significant advantage over the freehand technique in a plastic shoulder model. We obtained the best results when the anchors were positioned at the glenoid face.…”

Section: Discussionmentioning

confidence: 99%

Does Anchor Placement on the Glenoid Affect Functional Outcome After Arthroscopic Bankart Repair?

Park¹,

Lee²,

Chung

et al. 2018

Am J Sports Med

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“…One study compared the anchor positioning for anterior labral lesions in a plastic model arthroscopy versus navigated and showed a better accuracy regarding the deviation from the optimal insertion angle (p \ 0.05) in the navigation group [14]. In a cadaver model Kedgley et al showed improved kinematics of the navigation group after arthroplasty following a four-part fracture of the humeral head.…”

Section: Discussionmentioning

confidence: 99%

A novel method of image-based navigation in fracture surgery

Kraus

Dehner

Riepl

et al. 2012

Arch Orthop Trauma Surg

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The treatment of three- and four-part fractures of the humeral head is still controversially discussed. Some advocate primary arthroplasty while the results of primary fixation seem to be superior if no necrosis of the humeral head develops. Today navigation is used in orthopaedic surgery mainly for interventions on the spine, the pelvis and arthroplasty. In trauma surgery it is still rarely used and some technical problems need to be overcome. We report on a case of a three part fracture of the humeral head with mini-open reduction and fixation with image-based guided headless compression screws. For the fixation each screw was placed on the first trial, total radiation time was 60 s. At 12-month follow-up assessment radiographs showed a consolidated fracture, no loosening of the screws and a good glenohumeral articulation. The patient had free function of the shoulder and no pain, the constant score was 98 and the dash score 0. There is no evidence of a necrosis of the humeral head. The literature focuses on shoulder arthroplasty. There are no reports on the use of image-based guidance in shoulder traumatology so far. In conclusion, the described technique allows an accurate fixation of the humeral head fracture as the guidance system (Surgix) ensures the "first try first hit" screw positioning. The new system was integrated in the workflow and supports the surgeon as an aiming device. The role of navigation system in enhancing minimally invasive surgery of the shoulder should be further explored.

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Freehand versus navigated glenoid anchor positioning in anterior labral repair

Cited by 9 publications

References 20 publications

Glenoid Rim Anatomy

Glenoid Rim Anatomy

Does Anchor Placement on the Glenoid Affect Functional Outcome After Arthroscopic Bankart Repair?

A novel method of image-based navigation in fracture surgery

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