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Klabklay P, Kwanyuang A, Tangjatsakow P, Kala S, Suklim P, Naknual N, Chuaychoosakoon C. Comparing the Anatomical Landmarks Versus the Coracoid-Based Landmarks Techniques for Coracoclavicular Stabilization After High-Grade Acromioclavicular Injury: A Biomechanical Study. Orthop J Sports Med 2022; 10:23259671221132541. [PMID: 36419477 PMCID: PMC9676306 DOI: 10.1177/23259671221132541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND In acute high-grade acromioclavicular (AC) joint injuries, the aim of treatment is robust reduction and stabilization of the joint. The anatomical landmarks method is most commonly used for stabilization, but loss of reduction often occurs because of the suture tunnels. PURPOSE/HYPOTHESIS The purpose was to evaluate and compare the stability of coracoclavicular (CC) stabilization using the anatomical landmarks and coracoid-based landmarks techniques in treating a high-grade AC joint injury. It was hypothesized that stabilization using coracoid-based landmarks would provide better stability. STUDY DESIGN Controlled laboratory study. METHODS Twenty fresh-frozen cadaveric shoulders (8 male and 2 female pairs) were randomized into 2 operative technique groups: 10 shoulders in the anatomical landmarks group and 10 shoulders in the coracoid-based landmarks group. The CC ligaments and AC capsule were cut at the midlevel, and CC stabilization and AC capsule repair were performed. For the anatomical landmarks technique, two 2.5-mm clavicular tunnels were created at 25 and 45 mm from the AC joint, while for the coracoid-based landmarks technique, two 2.5-mm clavicular tunnels were drilled using the medial and lateral borders of the coracoid base to choose the tunnel sites. Before injury creation and after stabilization, each shoulder underwent a loading force of 70 N in the superior and anteroposterior directions, and the displacement distance and stiffness were compared between the 2 techniques using the paired t test. RESULTS The mean difference in displacement before and after stabilization was higher in the anatomical landmarks technique than the coracoid-based landmarks technique (1.82 ± 3.52 vs -0.18 ± 4.78 mm in the superior direction and 7.47 ± 9.35 vs 1.76 ± 3.91 mm in the anteroposterior direction), but none of the differences in displacement or stiffness were statistically significant between the groups. CONCLUSION No significant biomechanical differences in displacement or stiffness were seen between the anatomical landmarks technique and the coracoid-based landmarks technique. CLINICAL RELEVANCE Either stabilization technique can be utilized for repair of the CC ligaments in an acute AC injury setting.
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Affiliation(s)
- Prapakorn Klabklay
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Atichart Kwanyuang
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Preyanun Tangjatsakow
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sataporn Kala
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Phachara Suklim
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Nutnicha Naknual
- Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Zhang H, Fan T, Wu X, Li L, Li W, Lin L, Li J. An Accuracy Comparison of Minimally Invasive Transclavicular-Transcortical Drilling with Free-Hand, C-Shape and Assembly-Type Guide Device: An In Vitro Study. Orthop Surg 2022; 14:3390-3399. [PMID: 36254383 PMCID: PMC9732625 DOI: 10.1111/os.13514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Ensuring the accuracy of transclavicular-transcoracoid drilling in the anatomical reconstruction of the coracoclavicular ligament complex with minimally invasive incisions remains a major problem for inexperienced surgeons. The purpose of this study was to design an assembly guide device for transclavicular-transcoracoid drilling with minimally invasive incisions, to manufacture the finished product, and to compare its feasibility and accuracy with the existing C-shape guide devices and free-hand techniques. METHODS An assembly-type guide device was designed and produced using computer-aided design and three-dimensional printing. The specimen data of 54 human shoulders from 27 gross specimen (14 males and 13 females) treated by free-hand drilling, C-shape device drilling, and assembly-type guide device drilling from October 2018 to January 2021 were analyzed in a controlled laboratory study. Fifty-four human shoulder specimens were randomly assigned into free-hand (n = 18), C-shape (n = 18), and assembly (n = 18) groups by drawing lots for transclavicular-transcoracoid drilling by three inexperienced surgeons. After the drilling procedure was completed and the devices were removed, the operation outcomes were assessed and evaluated. Distances from the tunnel edge to the coracoid's medial (dm ) and lateral (dl ) edges, operation time, and tunnel location zones on the coracoid's inferior surface of all specimens in the three groups were measured to evaluate the surgical accuracy and efficiency. RESULTS All specimens in the three groups completed the drilling operation successfully and were correctly measured. The distance differences (dd ) between dm and dl in the free-hand, C-shape, and assembly groups were 3.2 ± 1.8 mm, 1.8 ± 1.0 mm, 1.0 ± 0.8 mm, respectively. The dd of the free-hand group was higher than that of the other two groups (p < 0.001). The tunnel exit points on the inferior coracoid surface located in undesired zones were six (33%), one (6%), and zero in the free-hand group, C-shape group, and assembly-type group, respectively (p = 0.012). The operation time in the free-hand, C-shape, and assembly groups were 198 ± 36 s, 256 ± 64 s, and 353 ± 88 s, respectively. The operation time of each group significantly differed from that of the others (p < 0.001). CONCLUSION The assembly-type devices may be the first choice for inexperienced surgeons while both the C shape devices and assembly-type guide devices achieved higher accuracy than free-hand techniques.
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Affiliation(s)
- Hongtao Zhang
- Department of OrthopedicsZhongshan Torch Development Zone People's HospitalZhongshanChina
| | - Tiancheng Fan
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical SciencesSouthern Medical UniversityGuangzhouChina
| | - Xiaowei Wu
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical SciencesSouthern Medical UniversityGuangzhouChina,Academy of Orthopedics of Guangdong Province, The Third Affiliated HospitalSouthern Medical UniversityGuangzhouChina
| | - Lutao Li
- Department of OrthopedicsZhujiang Hospital, Southern Medical UniversityGuangzhouChina
| | - Wenrui Li
- Nanfang College of Sun Yat‐Sen UniversityGuangzhouChina
| | - Lijun Lin
- Department of OrthopedicsZhujiang Hospital, Southern Medical UniversityGuangzhouChina
| | - Jianyi Li
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, School of Basic Medical SciencesSouthern Medical UniversityGuangzhouChina,Academy of Orthopedics of Guangdong Province, The Third Affiliated HospitalSouthern Medical UniversityGuangzhouChina
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Saengsirinavin P, Ratanalekha R, Piempuk N, Sriratanavudhi C, Jongthanakamol T, Jaroenporn W. The lateral collateral ligament complex of the elbow in a Thai population: an anatomical study of 56 cadaveric specimens. J Hand Surg Eur Vol 2022; 47:959-964. [PMID: 35850573 DOI: 10.1177/17531934221112545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to investigate the anatomical features of the lateral collateral complex (LCC) of the elbow in a Thai population. We dissected 56 cadaveric elbows and described the LCC three-dimensionally in sagittal and coronal planes. We found that the characteristics differed from previous reports in other ethnic populations. In the sagittal plane, the centre of the origin of the LCC was located 3 mm anteriorly and 4 mm inferiorly to the apex of the lateral humerus epicondyle, and in the coronal plane it was 4 mm deep. The vertical distance between the origin of the lateral ulnar collateral ligament (LUCL) and the lateral epicondyle and the distance from the LUCL insertion to the border of the ulnar bone differed significantly between sexes. These data may be useful for surgeons during reconstruction of injures to the LCC of the elbow.Level of evidence: V.
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Affiliation(s)
| | - Rosarin Ratanalekha
- Department of Anatomy, Siriraj hospital, Mahidol University, Bangkok, Thailand
| | - Noppadol Piempuk
- Department of Anatomy, Siriraj hospital, Mahidol University, Bangkok, Thailand
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Bhaskarwar AP, Dev Jaidev KP, Joshi RK, Mopagar V. Managing acute acromioclavicular joint dislocation during COVID 19 pandemic by minimally invasive technique with suture anchor and miniplate: A pilot study. Med J Armed Forces India 2022; 79:S0377-1237(22)00099-5. [PMID: 35996616 PMCID: PMC9385407 DOI: 10.1016/j.mjafi.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acromioclavicular (AC) joint dislocation is common in sportsmen and physically active population. Its management depends upon the grade of injury and functional demands of the patient. A variety of surgical procedures have been described with different limitations and advantages. The present study has assessed the clinical and radiological outcome of acute AC joint dislocation managed with a 3.5 mm Titanium suture anchor and 2 mm miniplate construct which requires lesser dissection, surgical time and thus contact with the patient as mandated by COVID-19 pandemic. Methods We enrolled 10 patients of Rockwood type-III, IV and V acute AC joint injury (<3 weeks old) reporting at this hospital from Feb 2020 to May 2021. All were tested for COVID-19 using reverse transcriptase polymer chain reaction test (RTPCR) and managed by closed/open reduction and fixation with a 3.5 mm Titanium Suture Anchor and a 2 mm Titanium miniplate construct. Follow-up was done at 3, 6 and 9 month post-operatively. Results The average age of patients was 31 yrs. RTPCR test for COVID-19 was negative in all patients. Median surgical time was 25 min (Interquartile Range[IQR] = 16-34 min) and median follow-up duration was 36 weeks (IQR = 33-39 weeks). Median visual analogue scale score and IQR at pre-operative, 3 month, 6 month and 9 month follow-up was 7(IQR = 6-8), 3.5(IQR = 2.5-4.5), 2(IQR = 0) and 1(IQR = 0), respectively. Median constant score at pre-operative, 3 month, 6 month and 9 month follow-up were 34(IQR = 25-43), 65.5(IQR = 60.5-70.5), 82.5(IQR = 77.5-87.5) and 88(IQR = 81-95). There was significant improvement in clinical status (non parametric-Friedman test p < 0.001). Radiographs showed no loss of reduction, fracture or implant failure till last follow-up. Conclusions Minimally invasive technique with a 3.5 mm Ti-suture anchor and 2 mm plate is an easy, fast and reliable construct for the management of acute AC dislocation in physically active population.
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Yin L, Zhang H, Kong Y, Zhang X, Yan W, Zhang J. Distance between the supraspinatus and long head of the biceps tendon on sagittal MRI: a new tool to identify anterior supraspinatus insertion injury. J Exp Orthop 2021; 8:108. [PMID: 34821972 PMCID: PMC8617234 DOI: 10.1186/s40634-021-00410-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Anterior insertion of the supraspinatus muscle plays an essential role in rotator cuff tissue. We aimed to determine whether the distance between the midpoints of the supraspinatus central tendon and long head of the biceps tendon on a sagittal shoulder magnetic resonance imaging scan can help to preoperatively diagnose an injury of the anterior insertion of the supraspinatus. METHOD This retrospective study reviewed 103 patients with a full-thickness supraspinatus tendon tear: 50 patients with (injured group) and 53 patients without (intact group) anterior supraspinatus insertion tear. The inter-tendon distance was measured based on an oblique sagittal magnetic resonance imaging scan. SPSS was used for statistical analyses. Two independent samples t-test and receiver operating curve analysis were also performed. RESULTS The measurements of inter-tendon distance revealed good intra- and inter-observer reliabilities with intra-class correlation coefficients of 0.92 and 0.97, respectively. The inter-tendon distance of the injured group was significantly greater than that of the intact group (10.1 ± 2.7 vs 8.0 ± 2.3 mm, P < 0.001). The diagnostic ability of the inter-tendon distance was fair (area under the curve = 0.745), and a threshold of 9 mm had a specificity of 73% and sensitivity of 74%. CONCLUSION The distance between the supraspinatus central tendon and long head of the biceps tendon on magnetic resonance imaging was greater in patients with anterior supraspinatus insertion injury than those without the injury. A distance of 9 mm may be the cut-off value and a good diagnosis marker for anterior supraspinatus insertion injury. LEVEL OF EVIDENCE Level III, diagnostic case-control study.
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Affiliation(s)
- Lifeng Yin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Hua Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Yangang Kong
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Xinyu Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Wenlong Yan
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China
| | - Jian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, NO.1 Youyi Road, Chongqing, 400016, Yuzhong District, China.
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Charilaou J, Dey R, Burger M, Sivarasu S, van Staden R, Roche S. Quantitative fit analysis of acromion fracture plating systems using three-dimensional reconstructed scapula fractures - A multi-observer study. SICOT J 2021; 7:36. [PMID: 34014164 PMCID: PMC8136237 DOI: 10.1051/sicotj/2021028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/17/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Surgical treatment of displaced acromial and scapula spine fractures may be challenging due to the bony anatomy and variable fracture patterns. This difficulty is accentuated by the limitations of the available scapular plates for fracture fixation. This study compares the quantitative fitting of anatomic scapular plates and clavicle plates, using three-dimensional (3D) printed fractured scapulae. METHODS Fourteen scapulae with acromion and spine fractures were used for this study. Computerized tomographic (CT) scans of the fractured scapulae were obtained from the Philips picture archiving and communication system (PACS) database of patients admitted to a tertiary teaching hospital in Cape Town, South Africa between 2012 and 2016. The reconstructed scapulae were 3D printed and the anatomical acromion and clavicle plates were templated about the fracture regions. The fit assessment was performed by five observers who classified the plates as no-fit, intermediate fit, and anatomical fit according to the surgical guidelines. RESULTS The 6-hole anterior clavicle plate performed better than any of the scapular plates as they were able to fit 45.7% of the fractured acromion, including the spine. Among the pre-contoured anatomical scapula plates, both the short and the long acromion plates could fit only 27.3% of the fractured acromion. The intraclass correlation coefficient was 0.965 suggesting excellent consensus among the five observers. CONCLUSION Clavicle plates were found to be better suited to fit around a scapula fracture in its acromion and spine region.
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Affiliation(s)
- Johan Charilaou
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
| | - Roopam Dey
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa
| | - Marilize Burger
- Faculty of Medicine and Health Sciences, Division of Orthopaedic Surgery, Stellenbosch University, 7935 Cape Town, South Africa
| | - Sudesh Sivarasu
- Department of Human Biology, Division of Biomedical Engineering, University of Cape Town, 7935 Cape Town, South Africa
| | - Ruan van Staden
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
| | - Stephen Roche
- Department of Surgery, Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa
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Chou ACC, Kang BJ, Tan AJ, Tjoen Lie DT. Arthroscopic repair is sufficient for treating recurrent shoulder instability in patients with bipolar bone defects and minor glenoid bone loss. J Orthop 2021; 24:5-8. [PMID: 33679020 DOI: 10.1016/j.jor.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 02/07/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Andrew Chia Chen Chou
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
- Duke-National University of Singapore Medical School, Singapore
| | | | - Aaron Junjie Tan
- Duke-National University of Singapore Medical School, Singapore
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
- Duke-National University of Singapore Medical School, Singapore
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Nagar M, Tiwari V, Joshi A, Ahmed M, Patel M. A cadaveric morphometric analysis of coracoid process with reference to the Latarjet procedure using the "congruent arc technique". Arch Orthop Trauma Surg 2020; 140:1993-2001. [PMID: 32870335 DOI: 10.1007/s00402-020-03579-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Congruent arc Latarjet procedure involves rotating the coracoid process so that its inferior surface is flush with the glenoid face, owing to their matching radius of curvature (ROC). However, there has been no cadaveric study to actually measure and compare the ROC of coracoid with glenoid, especially in Indian population. MATERIALS AND METHODS 44 shoulders were dissected in 24 cadavers to measure usable length of coracoid process, width, height, ROC of coracoid and glenoid as well as ulnar length (as proxy of cadaver height). Critical coracoid height and length were estimated based on screw sizes of 2.7 mm, 3.5 mm, 4 mm and 4.5 mm, and pair concordance between height and length calculated. ROC of coracoid and glenoid were compared to measure extent of congruency. RESULTS The mean usable length of coracoid process, width and height at mid-point were 21.8 mm, 13.7 mm and 8.6 mm, respectively. Out of the different screw sizes, 2.7 mm screws were found safe in 82% shoulders. 24 coracoid-glenoid pairs fulfilled the operational definition (≤ 5 mm) of congruency while rest 20 were seemingly incongruent chiefly due to coracoid variations, with mean ROC difference 4.13 mm (95% CI 1.51-6.74 mm). The ulnar length was significantly smaller in the incongruent ROC group (p = 0.0002). CONCLUSIONS The available length as well as height of the transferred coracoid must be considered when deciding optimum diameter fixation screws in Latarjet procedure. Owing to smaller anatomic dimensions of coracoid in Indian population, 2.7-mm screws provide the safest fixation option. Also, the ROC of coracoid and glenoid does not match in substantial proportion of the cadavers. Pre-operative planning should include a CT-based assessment of glenoid and coracoid dimensions to decide the technique of Latarjet procedure and the optimum diameter fixation screws required.
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Affiliation(s)
- Manoj Nagar
- Department of Trauma and Emergency (Orthopaedics), All India Institute of Medical Sciences, Bhopal, India
| | - Vivek Tiwari
- Department of Orthopaedics, All India Institute of Medical Sciences, Nagpur, India.
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Mohtashim Ahmed
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, India
| | - Manmohan Patel
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, India
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Minuesa-Asensio A, García-Esteo F, Mérida-Velasco JR, Barrio-Asensio C, de la Cuadra-Blanco C, Murillo-González J. Basic morphological characteristics of coracoid grafts obtained by open and arthroscopic Latarjet techniques: A comparative study. Orthop Traumatol Surg Res 2020; 106:1083-1087. [PMID: 32763008 DOI: 10.1016/j.otsr.2020.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 04/12/2020] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND A knowledge of the anthropometric characteristics of the coracoid graft (CG) that can be obtained by the open and arthroscopic Latarjet techniques may be beneficial in the preoperative planning and intraoperative decision making for coracoid osteotomy and transfer. We have not found any study that compared the morphology of the CG that can be obtained from open and arthroscopic Latarjet techniques. The purpose of this study was to verify if the basic anthropometric characteristics of CGs are equivalent. HYPOTHESIS We hypothesize that the basic anthropometric characteristics of the CGs are similar. METHODS Twenty fresh-frozen human paired cadaveric shoulder specimens that had been randomly distributed in two groups of 10 specimens each were used. Two surgeons, each with experience in performing the open and arthroscopic Latarjet technique, performed these procedures in each of the respective groups (OG, open group; AG, arthroscopic group). A CT scan was performed. Using the volume rendering technique, a metric analysis of the volume, area and length of the CG were performed, evaluated and statistically analysed. RESULTS There were no significant differences in length (p=0.162) (mean length, 22.6mm for OG and 23.6mm for AG). There were significant differences in the volume (p=0.031) and area (p=0.007) of the CG, being lower in the OG (mean volume, 2.8 cm3 for OG and 3.6 cm3 for AG; mean area, 9.9 cm2 for OG and 12.8 cm2 for AG). No significant differences were observed by sex or laterality. CONCLUSION The mean lengths of the CGs that were obtained by each technique are equivalent. However, the areas and volumes of the grafts are different, being lower in the open surgery. These differences have not been an impediment to perform the technique. Our results corroborates that consolidation is more related to the preparation and placement than to the anthropometric characteristics of the CG. No significant differences were observed by sex or laterality. LEVEL OF EVIDENCE Basic Science.
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Affiliation(s)
| | | | - José Ramón Mérida-Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Carmen Barrio-Asensio
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Crótida de la Cuadra-Blanco
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain.
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Boutsiadis A, Bampis I, Swan J, Barth J. Best implant choice for coracoid graft fixation during the Latarjet procedure depends on patients' morphometric considerations. J Exp Orthop 2020; 7:15. [PMID: 32185534 PMCID: PMC7078396 DOI: 10.1186/s40634-020-00230-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/04/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess the anthropometric dimensions of the coracoid process and the glenoid articular surface and to determine possible implications with the different commercially available Latarjet fixation techniques. METHODS In a total of 101 skeletal scapulae the glenoid length (GL), the glenoid width (GW), the coracoid length (CL), the coracoid width (CW) and the coracoid thickness (CTh) were measured. In order to assess the ability of the transferred coracoid to restore the glenoid anatomy we created a hypothetical model of 10%, 15%, 20%, 25% and 30% glenoid bone loss. We analyzed four common surgical fixation techniques for the Latarjet procedure (4.5 mm screws, 3.75 mm screws, 3.5 mm screws, and 2.8 mm button). The distances from the superior-inferior and medio-lateral limits of the coracoid using the four different fixation methods were calculated. We hypothesized that the "safe distance" between the implant and the coracoid osteotomy should be at least equal to the diameter of the implant. RESULTS The intra and inter-observer reliability tests were almost perfect for all measurements. The mean GH was 36.8 ± 2.5 mm, the GW 26.4 ± 2.2 mm, the CL 23.9 ± 3 mm, the CW 13.6 ± 2.mm, and the mean CTh was 8.7 ± 1.3 mm. The CL was < 25 mm in 46% of the cases. In cases with 25% and 30% bone loss, the coracoid graft restored the glenoid anatomy in 96% and 79.2% of the cases. With the use of the 4.5 mm screws the "safe distance" was present in 56% of the cases, with the 3.75 mm screws in 85%, with the 3.5 mm screws in 87%, and with the 2.8 mm button in 98% of the cases. The distance from the medio-lateral limit of the coracoid could be significantly increased (up to 9 mm) when smaller-button implants are used. CONCLUSIONS The coracoid graft could not always restore glenoid defects of 30%. Larger implants could be positioned too close to the osteotomy and the "medio-lateral offset" of the coracoid could be increased with smaller implants.
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Affiliation(s)
- Achilleas Boutsiadis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
| | - Ioannis Bampis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
| | - John Swan
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Parc sud galaxie, 5 Rue Des Tropiques, 38130 Echirolles, Grenoble, France
| | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Parc sud galaxie, 5 Rue Des Tropiques, 38130 Echirolles, Grenoble, France
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Jia Y, He N, Liu J, Zhang G, Zhou J, Wu D, Wei B, Yun X. Morphometric analysis of the coracoid process and glenoid width: a 3D-CT study. J Orthop Surg Res 2020; 15:69. [PMID: 32093704 PMCID: PMC7038565 DOI: 10.1186/s13018-020-01600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 02/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Data regarding the parameters of the coracoid process and glenoid width are insufficient, and information on gender, age, and ethnic differences in the parameters appear lacking in the Chinese population. This study aimed to investigate the morphometric parameters in the coracoid process and glenoid width. Methods Using our institution’s electronic database, we selected 84 patients (55 males and 29 females) who underwent a shoulder computed tomography (CT) scan from January 2017 to May 2018 in this study. Mimics19.0 software was used for three-dimensional (3D) reconstruction of CT and to measure the morphometric parameters of the coracoid process and glenoid width. Subgroup analyses stratified by gender and age were conducted and the parameters were compared with previously published reports. All data were statistically analysed by SPSS23.0 Statistical Package. Results A positive and significant relationship between the coracoid process and the glenoid width (R > 0.758, P < 0.01) was found. The midpoint width represents 52% (41–62%) of the glenoid width; the midpoint height, 40% (31–53%) of the glenoid width. Significant differences in all parameters between males and females were noted (P < 0.05). No significant differences among the age groups were observed (P > 0.05), whereas significant differences in almost all parameters between the ethnic groups were observed (P < 0.05). Conclusion Our results could supplement the information in the shoulder joint database with morphometric parameters and provide a reference for theoretical research on coracoid osteotomy, which may in turn help surgeons in the evaluation of coracoid process transfer.
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Affiliation(s)
- Yaofei Jia
- Department of Orthopedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, China.,Key Laboratory of Orthopedics of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China.,People's Hospital of Changwu County, Xianyang, 713600, Shaanxi, China
| | - Na He
- People's Hospital of Changwu County, Xianyang, 713600, Shaanxi, China
| | - Jiaxin Liu
- Department of Orthopedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, China.,Key Laboratory of Orthopedics of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Guangrui Zhang
- Department of Orthopedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, China.,Key Laboratory of Orthopedics of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Jianping Zhou
- Department of Orthopedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, China.,Key Laboratory of Orthopedics of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Ding Wu
- Department of Orthopedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, China.,Key Laboratory of Orthopedics of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Baomin Wei
- People's Hospital of Changwu County, Xianyang, 713600, Shaanxi, China
| | - Xiangdong Yun
- Department of Orthopedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, Gansu, China. .,Key Laboratory of Orthopedics of Gansu Province, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China.
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12
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Khan R, Satyapal K, Lazarus L, Naidoo N. An anthropometric evaluation of the scapula, with emphasis on the coracoid process and glenoid fossa in a South African population. Heliyon 2020; 6:e03107. [PMID: 31909271 PMCID: PMC6938878 DOI: 10.1016/j.heliyon.2019.e03107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/29/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
The exact dimensions of the scapula, including the coracoid process and glenoid fossa, are fundamental in the patho-mechanics of the glenohumeral joint (GHJ); as these structures act as initiators of shoulder movement. The aim of the study was to evaluate the anthropometric parameters of the GHJ, with emphasis on the coracoid process and glenoid fossa. The morphometric (Linear Tools 2012, 0-150mm, LIN 86500963) and morphological parameters of a total of one hundred and sixty-four (n = 164) dry bone scapulae [Right (R): 80; Left (L): 84, Male (M): 68; Female (F): 96] were recorded. Results: (i) Shape of glenoid fossa: Type 1: (R) 16.5%, (L) 11.0%; Male (M) 20.1%, Female (F) 7.3%; Type 2: (R) 14.0%, (L) 15.2%; (M) 18.3%, (F) 11.0%; Type 3: (R) 18.3%, (L) 25.0%; (M) 27.4%, (F) 15.9%. (ii) Notch type: Type 1: (R) 1.7%, (L) 7.3%; (M) 6.7%, (F) 2.4%; Type 2: (R) 47.0%, (L) 43.9%; (M) 59.2%, (F) 31.7%. (iii) Vertical diameter of glenoid fossa (VD) (mm): (R) 35.2 ± 3.1, (L) 34.9 ± 3.0; (M) 35.3 ± 3.2, (F) 34.6 ± 2.8. (iv) Horizontal diameter 1 (HD1) of glenoid fossa (mm): (R) 18.4 ± 3.3, (L) 17.5 ± 2.9; (M) 18.2 ± 3.3, (F) 17.4 ± 2.6. (v) Horizontal diameter 2 (HD2) of glenoid fossa (mm): (R) 24.5 ± 2.9, (L) 23.6 ± 2.6; (M) 24.2 ± 2.7, (F) 23.7 ± 2.8. (vi) Length of coracoid process (CL) (mm): (R) 41.7 ± 4.7, (L) 41.5 ± 4.9; (M) 42.1 ± 4.7, (F) 40.7 ± 4.8. (vii) Width of coracoid process (CW) (mm): (R) 13.3 ± 1.9, (L) 14.2 ± 11.9; (M) 13.1 ± 1.9, (F) 15.1 ± 14.5. (viii) Coracoglenoid distance (CGD) (mm): (R) 27.4 ± 8.3, (L) 28.2 ± 3.5; (M) 28.2 ± 7.4, (F) 27.0 ± 3.4. In the present study, Type 3 (oval) was observed to be the predominant glenoid fossa shape with a higher incidence in male individuals and on the right side. Although only notch Types 1 (without a notch) and 2 (with one notch) were observed in this study, Type 2 (one notch) was the most prevalent, presenting with a significant p-value (p = 0.019), suggesting that notch Type 1 (without a notch) and 2 (with one notch) are common findings in the right and left side of individuals. The findings observed in this study may provide knowledge regarding the role of the coracoid parameters in etiology of subcoracoid impingement while knowledge on the glenoid fossa parameters and variations are essential for evaluation in shoulder arthroplasty for glenoid fractures and anterior dislocations, and for glenoid prosthesis designs for the South African population.
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Affiliation(s)
- R. Khan
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - K.S. Satyapal
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - L. Lazarus
- Department of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - N. Naidoo
- Department of Basic Medical Sciences, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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13
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van Trikt CH, Dobbe JGG, Donders JCE, Streekstra GJ, Kloen P. The "coracoid tunnel view": a simulation study for finding the optimal screw trajectory in coracoid base fracture fixation. Surg Radiol Anat 2019; 41:1337-1343. [PMID: 31273419 PMCID: PMC6841653 DOI: 10.1007/s00276-019-02274-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Coracoid fractures represent approximately 3-13% of all scapular fractures. Open reduction and internal fixation can be indicated for a coracoid base fracture. This procedure is challenging due to the nature of visualization of the coracoid with fluoroscopy. The aim of this study was to develop a fluoroscopic imaging protocol, which helps surgeons in finding the optimal insertion point and screw orientation for fixations of coracoid base fractures, and to assess its feasibility in a simulation study. METHODS A novel imaging protocol was defined for screw fixation of coracoid base fractures under fluoroscopic guidance. The method is based on finding the optimal view for screw insertion perpendicular to the viewing plane. In a fluoroscopy simulation environment, eight orthopaedic surgeons were invited to place a screw down the coracoid stalk through the coracoid base and into the neck of 14 cadaveric scapulae using anatomical landmarks. The surgeons placed screws before and after they received an e-learning of the optimal view. Results of the two sessions were compared and inter-rater reliability was calculated. RESULTS Screw placement was correct in 33 out of 56 (58.9%) before, and increased to 50 out of 56 (89.3%) after the coracoid tunnel view was explained to the surgeons, which was a significant improvement (p < 0.001). CONCLUSIONS Our newly developed fluoroscopic view based on simple landmarks is a useful addendum in the orthopaedic surgeon's tool box to fixate fractures of the coracoid base.
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Affiliation(s)
- C H van Trikt
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J C E Donders
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic Trauma Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Arthroscopic Coracoacromial Ligament Transfer Augmented With Suspensory V-Shaped Fixation System for Chronic Acromioclavicular Joint Dislocation. Arthrosc Tech 2019; 8:e697-e703. [PMID: 31485395 PMCID: PMC6713877 DOI: 10.1016/j.eats.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/03/2019] [Indexed: 02/03/2023] Open
Abstract
Chronic acromioclavicular joint dislocations (ACJDs) develop when there is failure of conservative treatment, failed surgical treatment of acute ACJD, or simply missing the treatment in the acute healing phase. There is wide agreement that mechanical fixation alone in chronic ACJD is not sufficient and biological augmentation is necessary. Various arthroscopic techniques for reconstruction of the coracoclavicular ligament have been described, but allografts are expensive, are not available in all centers, carry the risk of disease transmission, and are "dead tissue" with a poor capacity for healing. Autografts are associated with donor-site morbidity and avascular structures. Moreover, these grafts are associated with a high risk of clavicular or coracoid fractures owing to large tunnels. We present an arthroscopic technique to transfer the coracoacromial ligament to the inferior surface of the lateral part of the clavicle in chronic ACJD, augmented with 2 clavicular buttons and a single coracoid button in a V-shaped configuration. The technique has various advantages including better stabilization, anatomic reconstruction, and a minimal risk of fracture of the coracoid and clavicle with small tunnels, using a vascularized graft with arthroscopic control of reduction.
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15
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Zhang L, Xu J, Fu S, Qin B, Liu Y, Yang Y, Wang M, Li D, Zhong S, Huang W. Distribution and Morphological Measurement of Bony Spurs on the Coracoid Process in a Chinese Population. Med Sci Monit 2019; 25:2527-2534. [PMID: 30953435 PMCID: PMC6463619 DOI: 10.12659/msm.913658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background There are few studies on distributions or morphological measurements for bony spurs form at the attachment points of the ligaments and tendons on the coracoid process. The aim of this study was to investigate their most common sites and morphological characteristics, and to propose possible reasons. Material/Methods Scapulae with bony spurs on the coracoid process were selected from 377 intact and dry Chinese scapulae. The distribution, height, and transverse and longitudinal diameter of the bony spurs were measured in each coracoid process. Results We selected 71 scapulae, 36 left and 35 right, that had bony spurs, from 377 scapulae. The bony spurs were most commonly located at the attachment point of the superior transverse scapular ligament (STSL) (31, 23.66%), while the trapezoid ligament (TL) accounted for the smaller proportion (8, 6.11%). The TSL was the highest, with the minimum transverse and longitudinal diameter, while the TL had the greatest transverse and longitudinal diameters. Only the TSL and TL had a statistically significant difference between the left and the right bony spur regarding the longitudinal diameter (P<0.05). Conclusions Bony spurs are more likely to form at the attachment points of ligaments and tendons on the coracoid process, which has a greater risk of traction injuries or attachment points avulsion fractures.
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Affiliation(s)
- Lei Zhang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Jie Xu
- School of Traditional Chinese Medicine, Southwest Medical University, Luzhou, Sichuan, China (mainland).,Southern Medical University Technology, Ltd., Shunde Science Park, Guangzhou, Guangdong, China (mainland)
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Bo Qin
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Yang Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Yang Yang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Southern Medical University Technology, Ltd., Shunde Science Park, Guangzhou, Guangdong, China (mainland).,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, Guangdong, China (mainland)
| | - Mian Wang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Southern Medical University Technology, Ltd., Shunde Science Park, Guangzhou, Guangdong, China (mainland).,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, Guangdong, China (mainland)
| | - Ding Li
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Southern Medical University Technology, Ltd., Shunde Science Park, Guangzhou, Guangdong, China (mainland).,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, Guangdong, China (mainland)
| | - Shizhen Zhong
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland)
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China (mainland).,Academician Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Southern Medical University Technology, Ltd., Shunde Science Park, Guangzhou, Guangdong, China (mainland).,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangzhou, Guangdong, China (mainland)
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Joshi D, Gupta LM, Tanwar M, Lal A, Chaudhary D. Anthropometric and Radiologic Measurements of Coracoid Dimensions and Clinical Implications in an Indian Population. Orthop J Sports Med 2018; 6:2325967118761635. [PMID: 29619396 PMCID: PMC5871059 DOI: 10.1177/2325967118761635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Recurrent shoulder dislocation and anterior instability are most commonly attributed to pathology of the capsulolabral complex with the presence of bony loss at the humeral and glenoid surfaces. Unassessed bone loss has been a cause of failure of primary soft tissue procedures or recurrence of symptoms, despite adequate address of soft tissue pathology. Purpose: To study the anthropometric and radiologic dimensions of the coracoid in relation to glenoid bone loss, its adequacy in filling glenoid defects in an Indian population, and whether the choice of surgical technique (congruent arc vs classical) and graft positioning alters the surgical results. This study also intended to establish whether computed tomography measurements correlate with actual anthropometric measurements. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 64 participants with 108 healthy shoulders were included in this study. Additionally, 100 skeletally mature bone specimens of the scapula were measured to assess glenoid diameter as well as coracoid width and length in 2 perpendicular planes with a humeral subtraction 3-dimensional en face glenoid view. Results: Specimen and participant measurements proved that the congruent arc technique was able to fill up to 50% more glenoid bone loss than the classical technique in an Indian population (mean ± SD, 13.45 ± 6.97 vs 7.96 ± 4.89 mm, respectively), with computed tomography being the best and most accurate modality to study it. The mean difference in the bone block length restoration of the glenoid bony arc was 5.41 ± 2.08 mm. Radii of curvature were congruent in populations of the Indian subcontinent. Conclusion: The congruent arc technique can be performed in an Indian population but with caution and careful presurgical assessment of bone loss. However, adequate coracoid dimension to accommodate the implant for fixation without failure must be ensured, as anthropometry suggests the existence of a subset of the population in whom the graft may have compromised width for accommodating standard implants for fixation.
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Affiliation(s)
- Deepak Joshi
- Sports Injury Centre, Safdarjung Hospital and VMMC, New Delhi, India
| | - Lalit Mohan Gupta
- Sports Injury Centre, Safdarjung Hospital and VMMC, New Delhi, India
| | - Milind Tanwar
- Sports Injury Centre, Safdarjung Hospital and VMMC, New Delhi, India
| | - Ajay Lal
- Sports Injury Centre, Safdarjung Hospital and VMMC, New Delhi, India
| | - Deepak Chaudhary
- Sports Injury Centre, Safdarjung Hospital and VMMC, New Delhi, India
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