Normalization of Glenohumeral Articular Contact Pressures After Latarjet or Iliac Crest Bone-Grafting

被引:139
作者
Ghodadra, Neil [1 ]
Gupta, Aman [1 ]
Romeo, Anthony A. [1 ]
Bach, Bernard R., Jr. [1 ]
Verma, Nikhil [1 ]
Shewman, Elizabeth [1 ]
Goldstein, Jordan [1 ]
Provencher, Matthew T. [1 ]
机构
[1] Rush Univ, Med Ctr, Dept Orthopaed Surg, Div Sports Med, Chicago, IL 60612 USA
关键词
RECURRENT ANTERIOR DISLOCATION; SHOULDER INSTABILITY; BRISTOW PROCEDURE; GLENOID DEFECT; FOLLOW-UP; REPAIRS; BANKART; OPERATION; RECONSTRUCTION; STABILITY;
D O I
10.2106/JBJS.I.00220
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Multiple bone-grafting procedures have been described for patients with glenoid bone loss and shoulder instability. The purpose of this study was to investigate the alterations in glenohumeral contact pressure associated with the placement and orientation of Latarjet or iliac crest bone graft augmentation and to compare the amount of glenoid bone reconstruction with two coracoid face orientations. Methods: Twelve fresh-frozen cadaver shoulders were tested in static positions of humeral abduction (30, 60, and 60 with 900 of external rotation) with a 440-N compressive load. Glenohumeral contact pressure and area were determined sequentially for (1) the intact glenoid; (2) a glenoid with an anterior bone defect involving 15% or 30% of the glenoid surface area; (3) a 30% glenoid defect treated with a Latarjet or iliac crest bone graft placed 2 mm proud, placed flush, or recessed 2 mm in relation to the level of the glenoid; and (4) a Latarjet bone block placed flush and oriented with either the lateral (Latarjet-LAT) or the inferior (Latarjet-INF) surface of the coracoid as the glenoid face. The amount of glenoid bone reconstructed was compared between the Latarjet-LAT and Latarjet-INF conditions. Results: Bone grafts in the flush position restored the mean peak contact pressure to 116% of normal when the iliac crest bone graft was used (p < 0.03 compared with the pressure with the 30% defect), 120% when the Latarjet-INF bone block was used (p < 0.03), and 137% when the Latarjet-LAT bone block was used (p < 0.04). Use of the Latarjet-LAT bone block resulted in mean peak pressures that were significantly higher than those associated with the iliac crest bone graft (p < 0.02) or the Latarjet-INF bone block (p < 0.03) at 60 of abduction and 90 of external rotation. With the bone grafts placed in a proud position, peak contact pressure increased to 250% of normal (p < 0.01) in the anteroinferior quadrant and there was a concomitant increase in the posterosuperior glenoid pressure to 200% of normal (p < 0.02), indicating a shift posteriorly. Peak contact pressures of bone grafts placed in a recessed position revealed high edge-loading. Augmentation with the Latarjet-LAT bone block led to restoration of the glenoid articular contact surface from the 30% defect state to a 5% defect state. Augmentation of the 30% glenoid defect with the Latarjet-INF bone block resulted in complete restoration to the intact glenoid articular surface area. Conclusions: Glenohumeral contact pressure is optimally restored with a flush iliac crest bone graft or with a flush Latarjet bone block with the inferior aspect of the coracoid becoming the glenoid surface. Bone grafts placed in a proud position not only increase the peak pressure anteroinferiorly, but also shift the articular contact pressure to the posterosuperior quadrant. Glenoid bone augmentation with a Latarjet bone block with the inferior aspect of the coracoid as the glenoid surface resulted in complete restoration of the 30% anterior glenoid defect to the intact state. These findings indicate the clinical utility of a flush iliac crest bone graft and utilization of the inferior surface of the coracoid as the glenoid face for glenoid bone augmentation with a Latarjet graft.
引用
收藏
页码:1478 / 1489
页数:12
相关论文
共 31 条
[1]   Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder [J].
Allain, J ;
Goutallier, D ;
Glorion, C .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1998, 80A (06) :841-852
[2]   A FREE BONE BLOCK OPERATION FOR RECURRENT ANTERIOR DISLOCATION OF THE SHOULDER JOINT [J].
BODEY, WN ;
DENHAM, RA .
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED, 1983, 15 (03) :184-188
[3]   Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion [J].
Burkhart, SS ;
De Beer, JF .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2000, 16 (07) :677-694
[4]   Results of modified latarjet anteroinferior instability reconstruction in patients with and significant bone loss [J].
Burkhart, Stephen S. ;
De Beer, Joe F. ;
Barth, Johannes R. H. ;
Criswell, Tim ;
Roberts, Chris ;
Richards, David P. .
ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY, 2007, 23 (10) :1033-1041
[5]   Management of bone loss associated with recurrent anterior glenohumeral instability [J].
Chen, AL ;
Hunt, SA ;
Hawkins, RJ ;
Zuckerman, JD .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2005, 33 (06) :912-925
[6]   Quantitative determination of articular pressure in the human shoulder joint [J].
Conzen, A ;
Eckstein, F .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2000, 9 (03) :196-204
[7]   Open repairs for the treatment of anterior shoulder instability [J].
Gill, TJ ;
Zarins, B .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2003, 31 (01) :142-153
[8]   Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid [J].
Greis, PE ;
Scuderi, MG ;
Mohr, RA ;
Bachus, KN ;
Burks, RT .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2002, 11 (05) :442-451
[9]   EDEN-HYBBINETTES OPERATION FOR RECURRENT DISLOCATION OF HUMERO-SCAPULAR JOINT [J].
HINDMARSH, J ;
LINDBERG, A .
ACTA ORTHOPAEDICA SCANDINAVICA, 1967, 38 (04) :459-+
[10]   One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years:: Study II -: the evolution of dislocation arthropathy [J].
Hovelius, L ;
Sandström, B ;
Saebö, M .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2006, 15 (03) :279-289