Laurent B Willemot1, Sarah F Eby2, Andrew R Thoreson3, Phillipe Debeer4, Jan Victor5, Kai-Nan An6, Olivier Verborgt7. 1. Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium. 2. Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA; Mayo Medical School, Mayo Graduate School, and Medical Scientist Training Program, College of Medicine, Mayo Clinic, Rochester, MN, USA. 3. Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA. 4. Division of Orthopaedics, Department of Development and Regeneration, KU Leuven, University Hospitals Leuven, Pellenberg, Belgium. 5. Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium. 6. Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA. Electronic address: an@mayo.edu. 7. Department of Orthopaedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium; Department of Orthopaedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium.
Abstract
BACKGROUND: Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. METHODS: Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. RESULTS: Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5 N vs 27.3 ± 6.9 N) and anteroinferior translation (22.0 ± 5.3 N vs 29.3 ± 6.9 N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. CONCLUSIONS: This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.
BACKGROUND: Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. METHODS: Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. RESULTS: Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5 N vs 27.3 ± 6.9 N) and anteroinferior translation (22.0 ± 5.3 N vs 29.3 ± 6.9 N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. CONCLUSIONS: This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.
Authors: Andrew S Bernhardson; James R Bailey; Daniel J Solomon; Mark Stanley; Matthew T Provencher Journal: Am J Sports Med Date: 2014-07-15 Impact factor: 6.202
Authors: Stephen S Burkhart; Joe F De Beer; Johannes R H Barth; Tim Cresswell; Tim Criswell; Chris Roberts; David P Richards Journal: Arthroscopy Date: 2007-10 Impact factor: 4.772
Authors: Laurent Willemot; Sara De Boey; Alexander Van Tongel; Geert Declercq; Lieven De Wilde; Olivier Verborgt Journal: Int Orthop Date: 2018-08-27 Impact factor: 3.075
Authors: Laurent B Willemot; Ross Wodicka; Adrian Bosworth; Alessandro Castagna; Joseph Burns; Olivier Verborgt Journal: Shoulder Elbow Date: 2017-04-29