Open Shoulder Repair of Osseous Glenoid Defects

Wellmann, Mathias; Petersen, Wolf; Zantop, Thore; Herbort, Mirco; Kobbe, Philipp; Raschke, Michael J.; Hurschler, Christof

doi:10.1177/0363546508326714

Cited by 107 publications

(28 citation statements)

References 41 publications

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“…[17] The supraspinatus, subscapularis, and the combination of the infraspinatus and teres minor were all loaded with 7.5 N each. The anterior, lateral and posterior heads of the deltoid were each loaded with 5 N.[18192021] Optical markers (Optotrak Certus, NDI, Waterloo, ON) were mounted on the scapula and humerus, and digitizations were made in order to create an Euler rotation sequence consistent with ISB standards. [22] Specifically, digitizations of the inferior angle, root of the spine, and the posterolateral aspect of the acromion were made on the scapula and used to create a scapular coordinate system.…”

Section: Methodsmentioning

confidence: 99%

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

Degen

Giles

Boons

et al. 2013

Int J Shoulder Surg

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Background:The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation. The effect of CAL release on superior stability following the Latarjet is unknown; therefore, our purpose was to compare the effect of two Latarjet techniques and allograft reconstruction on superior instability.Materials and Methods:Eight cadaveric specimens were tested on a simulator. Superior translation was monitored following an axial force in various glenohumeral rotations (neutral, internal, and external) with and without muscle loading. Three intact CAL states were tested (intact specimen, 30% glenoid bone defect, and allograft reconstruction) and two CAL deficient states (classic Latarjet (classicLAT) and congruent-arc Latarjet (congruentLAT)).Results:In neutral without muscle loading, a significant increase in superior translation occurred with the classicLAT as compared to 30% defect (P = 0.046) and allograft conditions (P = 0.041). With muscle loading, the classicLAT (P = 0.005, 0.002) and the congruentLAT (P = 0.018, 0.021) had significantly greater superior translation compared to intact and allograft, respectively. In internal rotation, only loaded tests produced significant results; specifically, classicLAT increased translation compared to all intact CAL states (P < 0.05). In external rotation, only unloaded tests produced significant results with classicLAT and congruentLAT allowing greater translations than intact (P ≤ 0.028). For all simulations, the allograft was not significantly different than intact (P > 0.05) and no differences (P = 1.0) were found between classicLAT and congruentLAT.Discussion:In most simulations, CAL release with the Latarjet lead to increased superior humeral translation.Conclusion:The choice of technique for glenoid bone loss reconstruction has implications on the magnitude of superior humeral translation. This previously unknown effect requires further study to determine its clinical and kinematic outcomes.

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Section: Methodsmentioning

confidence: 99%

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

Degen

Giles

Boons

et al. 2013

Int J Shoulder Surg

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“…Biomechanical studies have noted superiority of coracoid transfer procedures such as the Bristow and Latarjet procedures compared with purely structural grafts due to the advantage conveyed by the soft tissue attachments to the coracoid tip. 6 , 7 , 24 …”

mentioning

confidence: 99%

Latarjet Fixation

Alvi

Monroe

Muriuki

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure.Purpose:To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure.Study Design:Controlled laboratory study.Methods:Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws.Results:All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144).Conclusion:There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws.Clinical Relevance:Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option.

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“…The humeral and global coordinate system were defined as previously described. [ 18 ] At the time, the humeral head was centered in the glenoid the geometric center of the humeral head was defined to be zero point to measure anterior-posterior and superior-inferior translations. This zero point was saved for each specimen in the intact condition and re-established by the robot at the beginning of every following test condition.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical evaluation of inferior scapula notching of reverse shoulder arthroplasty depending on implant configuration and scapula neck anatomy

Smith¹,

Bäunker²,

Hurschler³

et al. 2015

Int J Shoulder Surg

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Purpose:The presence of inferior scapula notching is significantly affected by the anatomy the scapula and can be influenced by the glenosphere design and position and the onlay type.Materials and Methods:A biomechanical study was undertaken with 13 human shoulder specimens in a robot-assisted shoulder simulator. Inferior scapula contact during adduction of the humerus was detected using a contact pressure film. Computed tomography scans with three-dimensional reconstructions of each specimen were performed.Results:The greatest improvement of the scapula notching angle (SNA) was achieved by simultaneous implantation of a shallow humeral onlay and an eccentric glenosphere design: 16.3-19.0° (P < 0.005). The SNA was significantly decreased by 5.8° when shifting from a 38 mm centric glenosphere to a 42 mm centric glenosphere (P < 0.005) and by 8.9° comparing the 38 mm centric glenosphere with 38 mm eccentric glenosphere (P < 0.005). The solitary implantation of a shallow onlay significantly decreased the SNA depending on the glenosphere size between 7.4° and 8.0° (P = 0.001). A more inferior position of the metaglene as well as a long scapula neck (P = 0.029) and a large lateral scapula pillar angle (P = 0.033) were correlated with a lower SNA.Conclusion:This study demonstrates the importance of inferior glenosphere placement and the benefit of eccentric glenosphere and shallow humeral cup design to reduce the adduction deficit of the reverse shoulder. The presence of a short neck of the scapula can have a negative prognostic effect on inferior impingement during adduction of the arm.Level of Evidence:Basic Science Study

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Open Shoulder Repair of Osseous Glenoid Defects

Abstract: On the basis of the results of this biomechanical study, the authors recommend the Latarjet procedure for restoring stability in shoulders with a significant glenoid bone defect.

Cited by 107 publications

References 41 publications

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

Latarjet Fixation

Biomechanical evaluation of inferior scapula notching of reverse shoulder arthroplasty depending on implant configuration and scapula neck anatomy

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