Restoration of Articular Geometry Using Current Graft Options for Large Glenoid Bone Defects in Anterior Shoulder Instability

Willemot, Laurent; Akbari-Shandiz, Mohsen; Sánchez-Sotelo, Joaquín; Zhao, Kristin D.; Verborgt, Olivier

doi:10.1016/j.arthro.2017.04.002

Cited by 28 publications

(21 citation statements)

References 47 publications

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“…6,11,16 Coronal ROC congruence has been most extensively studied, and in our study, all structures were consistently concave in their corresponding plane. 3,8,28,47 While the coronal ROC of all structures significantly differed from the glenoid, this should be interpreted cautiously given the weak reliability measures seen. Additionally, a large ROC mismatch may translate to manageable differences in actual curve depth and graft stepoff (Table 3), especially if recontoured by the surgeon.…”

Section: Discussionmentioning

confidence: 92%

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Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site

et al. 2019

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Background: Current structural bone graft options used for glenoid augmentation in glenohumeral instability have known drawbacks. The scapular spine may be a possible alternative graft choice, but its dimensions and anatomy are not fully reported. Hypothesis: The scapular spine’s harvestable graft dimensions will be similar to harvestable dimensions of the coracoid and iliac crest. Study Design: Descriptive laboratory study. Methods: The scapular spine, coracoid, and iliac crest dimensions were recorded and compared bilaterally in 50 patients with 3-dimensional computed tomography imaging. The portion of the scapular spine with the largest harvestable dimensions was quantified and its location defined. Measurements were independently taken by 2 investigators and averaged for the final result. Results: The scapular spine has 81.5 mm of harvestable length and a “flare” located approximately 49.6 mm lateral to the medial scapular border, where the widest harvestable cross section is located (mean harvestable dimensions: 10.9-mm height, 11.5-mm width). Mean coracoid dimensions were 24-mm length, 14.2-mm height, and 10.6-mm width. Mean iliac crest width was 14.7 mm. In sum, 96% of scapular spines, 85% of coracoids, and 100% of iliac crests exceeded minimum dimensions of 8 mm × 8 mm × 20 mm. The coronal radius of curvature of the glenoid was significantly different from the corresponding plane of all measured structures. Conclusion/Clinical Relevance: The scapular spine has dimensions similar to the coracoid and iliac crest in the majority of patients and is therefore appropriate for further investigation as a potential graft choice in glenohumeral instability. A harvest location 49.6 mm lateral to the medial scapular border will provide the largest cross-sectional graft while avoiding the acromial base.

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Section: Discussionmentioning

confidence: 92%

“…If the inner table did not show biplanar concavity but the outer table did, then the outer table was selected instead. 47 Axial ROC measurements were taken over a length of 20 mm, centered on IC 2 , at an inferior depth of 8 mm. Coronal plane ROC measurements were taken along the superior 1 cm of the inner/outer table at IC 2 .…”

Section: Roc Measurementsmentioning

confidence: 99%

Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site

et al. 2019

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“…23,25 For instance, in shoulder instability with glenoid defects, the goal is to obtain a bone graft that reconstructs the missing bone segment accurately with a ROC near to native. 25,38 The mode 3 and its corresponding measurements emphasize the substantial variance in small nuances of the articular surface that potentially influence shoulder function. These are difficult to capture with current methods like templates based on the mean shape of a normal population, or idealizing the anatomy to the underlying geometry.…”

Section: Discussionmentioning

confidence: 99%

Thinking outside the glenohumeral box: Hierarchical shape variation of the periarticular anatomy of the scapula using statistical shape modeling

Jacxsens

Elhabian

Brady

et al. 2020

Journal Orthopaedic Research

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Variation in the shape of the glenoid and periarticular anatomy of the scapula has been associated with shoulder pathology. The goal of this study was to identify the modes of shape variation of periarticular scapular anatomy in relation to the glenoid in nonpathologic shoulders. Computed tomography scans of 31 cadaveric scapulae, verified to be free of pathology, were three‐dimensionally reconstructed. Statistical shape modeling and principal component analysis identified the modes of shape variation across the population. Corresponding linear and angular measurements quantified the morphometric variance identified by the modes. Linear measures were normalized to the radius of the inferior glenoid to account for differences in the scaling of the bones. Five modes captured 89.7% of total shape variation of the glenoid and periarticular anatomy. Apart from size differences (mode 1: 33.0%), acromial anatomy accounted for the largest variation (mode 2: 32.0%). Further modes described variation in glenoid inclination (mode 3: 11.8%), coracoid orientation and size (mode 4: 9.0%), and variation in coracoacromial (CA) morphology (mode 5: 3.1%). The average scapula had a mean acromial tilt of 49 ± 7°, scapular spine angle of 61 ± 6°, the glenoid inclination of 84 ± 4°, coracoid deviation angle of 26 ± 4°, coracoid length of 3.7 ± 0.3 glenoid radii, and a CA base length of 5.6 ± 0.5 radii. In this study, the identified shape modes explain almost all of the variance in scapular anatomy. The acromion exhibited the highest variance of all periarticular anatomic structures of the scapula in relation to the glenoid, which may play a role in many shoulder pathologies.

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“…After stability testing, another CT scan was performed for 5 shoulders with the 3D-printed implant in situ and 5 shoulders after the Latarjet for evaluation of the geometry of the defect repair. The images were uploaded into Mimics Medical to compare the glenoid width (the widest anteroposterior diameter measured parallel to the superior-inferior axis) and the cavity depth (measured as described by Willemot et al 25 ) among the intact, defect, and post-reconstruction conditions.…”

Section: Methodsmentioning

confidence: 99%

A Novel Treatment for Anterior Shoulder Instability

Willemsen

Berendes

Geurkink

et al. 2019

The Journal of Bone and Joint Surgery

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Background: Anterior glenohumeral instability with >20% glenoid bone loss is a disorder that can be treated with the Latarjet stabilizing procedure; however, complications are common. The purposes of this study were to (1) evaluate the effect of an anatomic-specific titanium implant produced by 3-dimensional (3D) printing as a treatment option for recurrent shoulder instability with substantial glenoid bone loss and (2) compare the use of that implant with the Latarjet procedure. Methods: Ten fresh-frozen cadaveric shoulders (mean age at the time of death, 78 years) were tested in a biomechanical setup with the humerus in 30° of abduction and in neutral rotation. The shoulders were tested under 5 different conditions: (1) normal situation, (2) creation of an anterior glenoid defect, (3) implantation of an anatomic-specific titanium implant produced by 3D printing, and the Latarjet procedure (4) with and (5) without 10 N of load attached to the conjoined tendon. In each condition, the humerus was translated 10 mm anteriorly relative to the glenoid, and the maximum peak translational force that was necessary for this translation was measured. Results: After creation of the glenoid defect, the mean translational peak force decreased by 30% ± 6% compared with that for the normal shoulder. After restoration of the original glenoid anatomy, the translational force needed to dislocate the humeral head from the glenoid significantly increased compared with that in the defect condition—to 119% ± 16% of normal (p < 0.01) with the 3D-printed anatomic-specific implant and to 121% ± 48% of normal (p < 0.01) following the Latarjet procedure. No significant differences in mean translational force were found between the anatomic-specific implant and the Latarjet procedure (p = 0.72). Conclusions: The mean translational peak force needed to dislocate the humerus 10 mm anteriorly on the glenoid was higher after glenoid restoration with the 3D-printed anatomic-specific implant compared with when the glenoid had a 20% surface defect but also compared with when the glenoid was intact. No differences in mean translational peak force were found between the 3D-printed anatomic-specific glenoid implant and the Latarjet procedure, although there was less variability in the 3D-implant condition. Clinical Relevance: Novel 3D-printing technology could provide a reliable patient-specific alternative to solve problems related to traditional treatment methods for shoulder instability.

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Restoration of Articular Geometry Using Current Graft Options for Large Glenoid Bone Defects in Anterior Shoulder Instability

Cited by 28 publications

References 47 publications

Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site

Scapular Spine Dimensions and Suitability as a Glenoid Bone Graft Donor Site

Thinking outside the glenohumeral box: Hierarchical shape variation of the periarticular anatomy of the scapula using statistical shape modeling

A Novel Treatment for Anterior Shoulder Instability

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