Jan Arild Klungsøyr1,2, Terje Vagstad3, Manuel Ferle4, Jon Olav Drogset5,6, Solveig Roth Hoff7,8, Andreas F Dalen3, Christof Hurschler4, Christian von Falck9, Peter Klungsøyr3. 1. Orthopedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway. janarild.klungsoyr@gmail.com. 2. Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway. janarild.klungsoyr@gmail.com. 3. Orthopedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway. 4. Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover-Annastift, Hannover, Germany. 5. Norwegian University of Science and Technology, Trondheim, Norway. 6. Trondheim University Hospital, Trondheim, Norway. 7. Department of Radiology, Møre and Romsdal Hospital Trust, Ålesund, Norway. 8. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway. 9. Institut für Diagnostische und Interventionelle Radiologie Medizinische Hochschule Hannover (MHH) Hannover, Hannover, Germany.
Abstract
PURPOSE: Treatment of anterior glenoid bone loss in patients with recurrent anterior shoulder instability is a challenge. The subscapular sling method with quadriceps tendon bone (QTB) graft is a modification of the subscapular sling with a semitendinosus (ST) graft. The aim of the study was to test the biomechanical stability of the QTB sling procedure in human shoulder cadavers with severe anterior glenoid bone loss. METHODS: Fourteen cadaveric shoulders were tested with a force-moment-guided robot in three conditions: physiologically intact, anterior glenoid bone resection, and the subscapular sling procedure with a QTB graft. Joint stability was measured in anterior, anterior inferior and inferior directions in four glenohumeral joint positions: 0° and 60° of glenohumeral abduction, with each at 0° and 60° of external rotation. Maximum external rotation was measured at 0° and 60° glenohumeral abduction. Computer tomography scans were obtained preoperatively to plan the glenoid bone resection, as well as postoperatively to calculate the proportion of the glenoid bone actually resected. RESULTS: Significantly decreased translations were observed in the shoulders with the QTB sling compared to the intact joint and the glenoid bone loss model. No significant differences in maximum external rotation were observed between the three different conditions. CONCLUSION: This biomechanical study revealed a significant stabilizing effect of the arthroscopic subscapular QTB graft sling procedure in human shoulder cadavers without compromising external rotation. Clinical trials may reveal the usefulness of this experimental method.
PURPOSE: Treatment of anterior glenoid bone loss in patients with recurrent anterior shoulder instability is a challenge. The subscapular sling method with quadriceps tendon bone (QTB) graft is a modification of the subscapular sling with a semitendinosus (ST) graft. The aim of the study was to test the biomechanical stability of the QTB sling procedure in human shoulder cadavers with severe anterior glenoid bone loss. METHODS: Fourteen cadaveric shoulders were tested with a force-moment-guided robot in three conditions: physiologically intact, anterior glenoid bone resection, and the subscapular sling procedure with a QTB graft. Joint stability was measured in anterior, anterior inferior and inferior directions in four glenohumeral joint positions: 0° and 60° of glenohumeral abduction, with each at 0° and 60° of external rotation. Maximum external rotation was measured at 0° and 60° glenohumeral abduction. Computer tomography scans were obtained preoperatively to plan the glenoid bone resection, as well as postoperatively to calculate the proportion of the glenoid bone actually resected. RESULTS: Significantly decreased translations were observed in the shoulders with the QTB sling compared to the intact joint and the glenoid bone loss model. No significant differences in maximum external rotation were observed between the three different conditions. CONCLUSION: This biomechanical study revealed a significant stabilizing effect of the arthroscopic subscapular QTB graft sling procedure in human shoulder cadavers without compromising external rotation. Clinical trials may reveal the usefulness of this experimental method.
Entities:
Keywords:
Arthroscopic sling procedure; Biomechanical cadaver study; Glenoid bone loss; Quadriceps tendon bone graft; Shoulder instability; Subscapular tendon
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