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Nair AV, Panakkal JJ, Mohan PK, Rambhojan M, Thampy J S, Khan PS. Clinical and radiological outcome following arthroscopic Latarjet with cerclage FiberTape fixation with a minimum 1-year follow-up. JSES Int 2024; 8:946-953. [PMID: 39280165 PMCID: PMC11401552 DOI: 10.1016/j.jseint.2024.03.020] [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] [Indexed: 09/18/2024] Open
Abstract
Background The rates of implant-related complications are significant following the Latarjet procedure using metal screws in patients with recurrent shoulder dislocation and bone loss. The purpose of this study is to evaluate the short-term outcome following the arthroscopic Latarjet procedure using cerclage FiberTape (Arthrex, Naples, FL, USA) combined with remplissage and capsulolabral repair. It was hypothesized that performing the procedure with cerclage FiberTape would provide sturdy fixation, comparable to the conventional method of using metal screws, while averting hardware-related complications attributed to the latter in published literature. Methods A prospective study was performed in a single institution between 2020 and 2022, with all surgeries performed by a single fellowship-trained shoulder surgeon who has ample experience in performing arthroscopic screw Latarjet procedures. Patient demographics, number of dislocations before surgery, arm dominance, ligamentous laxity, type of sporting activity, Instability Severity Index Score, and percentage of bone loss on the glenoid and humeral sides were recorded. The patients were followed up with visual analog scale, American Shoulder and Elbow Surgeons score, Rowe score, and Walch-Duplay score preoperatively and postoperatively. The coracoid graft position, healing, and remodeling were assessed with computed tomography scans at 3 months postoperatively. Minimum clinical follow-up was for a period of one year. Results Overall, 10 patients (all males, average age 28 ± 8.8 years) were operated on with an arthroscopic Latarjet procedure using cerclage FiberTape. The minimum follow-up period was 12 months, and the mean follow-up was 13.2 months. The median and individual visual analog scores during arm motion, American Shoulder and Elbow Surgeons scores, Rowe scores, and Walch-Duplay scores improved in the follow-up period. Computed tomography scans at 3 months showed flushed graft position in 5 patients, medial graft position in two patients, and three patients showed graft nonunion with migration. Out of 10 patients, seven had good graft union in follow-up scans. None of the patients required revision surgery. All three patients with graft nonunion were kept under follow-up beyond the study period for recurrence of instability. Conclusion Our study demonstrated that arthroscopic Latarjet using cerclage FiberTape fixation combined with remplissage and capsulolabral repair resulted in high rate of graft loosening and migration (30%). Nonetheless, patients in whom the coracoid graft had united, as well as those in whom it had not, all had good to excellent functional and clinical outcomes, no complications, and did not require any revision surgery.
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Affiliation(s)
- Ayyappan V Nair
- Department of Orthopaedics, Manipal Whitefield Hospital, Banglore, Karnataka, India
| | - Jiss Joseph Panakkal
- Department of Orthopaedics, Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Pramod K Mohan
- Department of Orthopaedics, Manipal Whitefield Hospital, Banglore, Karnataka, India
| | | | - Sreejith Thampy J
- Department of Orthopaedics, Manipal Whitefield Hospital, Banglore, Karnataka, India
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Rosenow CS, Leland DP, Camp CL, Barlow JD. Sutures, Screws, Buttons, and Anchors: A Review of Current Bone Graft Fixation Devices for Glenoid Bone Loss in the Unstable Shoulder. Curr Rev Musculoskelet Med 2024; 17:207-221. [PMID: 38587597 DOI: 10.1007/s12178-024-09895-x] [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] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW Anterior shoulder instability is associated with concomitant injury to several stabilizing structures of the shoulder, including glenoid bone loss. While instability is most common in young athletes and patients with predisposing conditions of hyperlaxity, recurrent shoulder instability can occur throughout various age ranges and may lead to longer term effects including pain and shoulder arthritis. Glenoid bone loss exceeding certain thresholds is generally treated by glenoid reconstruction via bone block augmentation to adequately stabilize the glenohumeral joint. These procedures increase the width of the articular surface on which the humeral head can translate before dislocation and, based on the procedure performed, provide a sling effect via the conjoined tendon, and increase tension to support the anterior capsule. The purpose of this review is to summarize the available literature regarding bone block fixation techniques. RECENT DEVELOPMENTS Various fixation techniques have been utilized to secure bone block transfers. Though screw fixation has traditionally been used for bone block fixation, suture buttons, suture anchors, and all-suture techniques have been utilized in attempts to avoid complications associated with the use of screws. Biomechanical studies report variable force-resistance, displacement, and mode of failure when comparing screw to suture button-based fixation of glenoid bone blocks. Clinical and radiographic studies have shown these novel suture-based techniques to be comparable, and in some cases advantageous, to traditional screw fixation techniques. While screw fixation has long been the standard of care in glenoid bone block procedures, it is associated with high complication rates, leading surgeons to endeavor toward new fixation techniques. In available biomechanical studies, screw fixation has consistently demonstrated high maximal load-to-failure and displacement with cyclic loading. Studies have reported similar clinical and radiographic outcomes in both screw and suture-based fixation methods, with evidence of reduced bone resorption with suture fixation. While suture button fixation is associated with a higher rate of recurrent instability, overall complication rates are low. Future research should address biomechanical shortcomings of suture-based fixation techniques and continue to assess long-term follow-up of patients treated with each fixation method.
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Affiliation(s)
- Christian S Rosenow
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
| | - Devin P Leland
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
| | - Christopher L Camp
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA.
| | - Jonathan D Barlow
- Mayo Clinic Department of Orthopedic Surgery, 200 First Street SW, Rochester, 55905, MN, USA
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Gao A, Song Q, Shao Z, Pan H, Cui G. Inlay structure can improve bone graft stability in the Bristow procedure. J Shoulder Elbow Surg 2024; 33:781-791. [PMID: 37778656 DOI: 10.1016/j.jse.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/09/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Compared with the Latarjet procedure, the Bristow procedure has a lower screw-related complication rate but poor bone healing. A modified Inlay Bristow procedure has been reported to significantly improve the bone healing rate, but the biomechanical mechanism is unclear. The aim of this study was to evaluate the biomechanical stability of the bone graft between a modified Inlay Bristow procedure and the classic Bristow procedure. METHODS Sixteen left scapula models (Sawbones, Composite Scapula, and fourth generation) were randomly divided into 2 groups (8:8). The bone graft in the first group was fixed with a 3.5 mm screw using the Inlay structure. The bone graft in the second group was fixed with a 3.5 mm screw via the traditional method. The maximum cyclic displacement, ultimate failure load and stiffness were evaluated biomechanically. The failure type was recorded for each model. RESULTS Cyclic loading tests demonstrated that the maximum cyclic displacement of the Inlay procedure was significantly smaller (P = .001) than that of the classic procedure. The Inlay Bristow technique resulted in a significantly higher (P = .024) ultimate failure load than the classic Bristow technique. The stiffness of the classic group was 19.17 ± 4.01 N/mm and that of the inlay group was 22.34 ± 5.35 N/mm (P = .232). Failure was mainly due to bone graft fractures through the drill hole or glenoid bone fractures. CONCLUSION Inlay Bristow fixation of the bone graft in a Sawbones model provides significantly stronger fixation and better time point zero stability than classic Bristow fixation, suggesting a higher likelihood of graft union.
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Affiliation(s)
- Aofei Gao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China; The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Qingfa Song
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Haile Pan
- The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.
| | - Guoqing Cui
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Paul K, Elphingstone JW, Williams M, Manfredi JN, Jardaly A, Schick S, Floyd S, Brabston EW, Momaya AM, Ponce BA. Suspensory fixation for bone transfer procedures in shoulder instability is superior to screws in an angled construct: a biomechanical analysis. JSES Int 2024; 8:250-256. [PMID: 38464447 PMCID: PMC10920126 DOI: 10.1016/j.jseint.2023.09.008] [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] [Indexed: 03/12/2024] Open
Abstract
Background The Latarjet procedure is a common bony augmentation procedure for anterior shoulder instability. Historically, screw fixation is used to secure the coracoid graft to the anterior glenoid surface; however, malpositioning of the graft leads to oblique screw insertion that contributes to complications. Suture buttons (SBs) are a more recent fixation technique that have not been studied alongside standard screw fixation in the context of biomechanical models of angulated fixation. This study aims to compare the biomechanical strength of single and double, screw and SB fixation at various levels of angulation. Methods Testing was performed using polyurethane models from Sawbones. The graft piece was secured with screw fixation (Arthrex, Naples, FL, USA) or suspensory button (ABS Tightrope, Arthrex, Naples, FL, USA). Single or double constructs of screws and SBs were affixed at 0°, 15°, and 30° angles to the face of the glenoid component. An aluminum testing jig held the samples securely while a materials testing system applied loads. Five constructs were used for each condition and assessed load to failure testing. Results For single fixation constructs, suspensory buttons were 60% stronger than screws at 0° (P < .001), and 52% stronger at 15° (P = .004); however, at 30°, both were comparable (P = .180). Interestingly, single suspensory button at 15° was equivalent to a single screw at 0° (P = .310). For double fixation, suspensory buttons (DT) were 32% stronger than screws at 0° (P < .001) and 35% stronger than screws at 15° (P < .001). Both double fixation methods were comparable at 30° (P = .061). Suspensory buttons at 15° and 30° were equivalent to double screws at 0 (P = .280) and 15° (P = .772), respectively. Conclusion These measurements indicate that the suspensory button has a significantly higher load to failure capacity over the screw fixation technique, perpendicularly and with up to 15° of angulation. These analyses also indicate that the suspensory button fixation offers superior strength even when positioned more obliquely than the screw fixation. Therefore, suspensory button fixation may confer more strength while offering greater margin for error when positioning the graft.
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Affiliation(s)
- Kyle Paul
- Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Joseph W. Elphingstone
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marshall Williams
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
| | - John N. Manfredi
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Achraf Jardaly
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
| | - Samuel Schick
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Floyd
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eugene W. Brabston
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amit M. Momaya
- Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent A. Ponce
- Department of Orthopedic Surgery, The Hughston Clinic, Columbus, GA, USA
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Manfredi JN, Schick S, Paul KD, Elphingstone JW, Sowell J, Lameka M, Brabston EW, Momaya AM, Ponce BA. A Systematic Review of Screw and Suture Button Glenoid Augmentation Constructs. Orthop J Sports Med 2023; 11:23259671231186429. [PMID: 37840899 PMCID: PMC10571685 DOI: 10.1177/23259671231186429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/11/2023] [Indexed: 10/17/2023] Open
Abstract
Background Glenohumeral dislocations often lead to glenoid bone loss and recurrent instability, warranting bony augmentation. While numerous biomechanical studies have investigated fixation methods to secure a graft to the glenoid, a review of available constructs has yet to be performed. Purpose To synthesize the literature and compare the biomechanics of screw and suture button constructs for anterior glenoid bony augmentation. Study Design Systematic review. Methods A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. There were 2 independent reviewers who performed a literature search using the PubMed, Embase, and Google Scholar databases of studies published between 1950 and 2020. Studies were included that compared the biomechanical outcomes of fixation for the treatment of anterior shoulder instability with glenoid bone loss. Results Overall, 13 of the 363 studies screened met the inclusion criteria. The included studies measured the biomechanical strength of screws or suture buttons on a cadaveric or synthetic Latarjet construct. Screws and suture buttons were biomechanically similar, as both constructs exhibited comparable loads at failure and final displacement. Screw type (diameter, threading, or composition) did not significantly affect construct strength, and double-screw fixation was superior to single-screw fixation. Additionally, 2 screws augmented with a small plate had a higher load at failure than screws that were not augmented. Unicortical double-screw fixation was inferior to bicortical double-screw fixation, although construct strength did not significantly decrease if 1 of these screws was unicortical. Further, 2 screws inserted at 15° off axis experienced significantly higher graft displacement and lower ultimate failure loads than those inserted at 0° parallel to the glenoid. Conclusion Suture buttons provided comparable strength to screws and offer an effective alternative to reduce screw-related complications. Augmentation with a small plate may clinically enhance construct strength and decrease complications through the dispersion of force loads over a greater surface area. Differences in screw type did not appear to alter construct strength, provided that screws were placed parallel to the articular surface and were bicortical.
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Affiliation(s)
- John N. Manfredi
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Samuel Schick
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyle D. Paul
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Joseph W. Elphingstone
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Josiah Sowell
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Megan Lameka
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Eugene W. Brabston
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Amit M. Momaya
- Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Stirma GA, Ribeiro LM, Gaio ED, Belangero PS, Antonio de Figueiredo E, de Castro Pochini A, Andreoli CV, Ejnisman B. What is the best position for coracoid fixation in the Latarjet procedure? JSES Int 2022; 6:748-754. [PMID: 36081693 PMCID: PMC9446280 DOI: 10.1016/j.jseint.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypothesis Multiple problems and complications associated with Latarjet fixation have been described; thus, this is the first study in the literature to identify the maximum allowed screw clamping force and best fixation screw position for Latarjet surgery. Methods A variation of distal and proximal coracoid screw positions with and without a flat washer was evaluated through finite element analysis, at a minimum distance of 3 mm from the edge. A loading progression test was performed until the maximum stress reached a limit imposed by the bone yield. We identified the maximum allowed screw clamping force based on a von Mises and maximum principal stresses failure theory. Results When using the flat washer, the cortical bone generally has only space for 1 piece. For this reason, as a primary study, it was observed that when the distal screw was more than 7 mm from the edge, the clamping force supported will be higher than that during the proximal fixation regardless of the proximal location screw. We have found that the best position is 7 mm from the distal edge, with the highest compression of 445 N (7 mm proximal distance, 5 mm distal distance) in due respect to the von Mises failure theory. To get around this lack of space situation, in this study, we have proposed a fixation plate to replace the flat washer. This plate has shown very interesting values when compared to the previously flat washer study, but now, for both screw holes. With those results, we can assure that using a fixation plate like this will ensure surgery safety and higher allowed compression force when clamping the bolts. Conclusion The distal screw provided higher tensile strength values when located more than 7 mm from the coracoid edge. The geometry of the coracoid in its distal position supports higher stress loads than in the proximal position. When the flat washer was in the proximal position, the coracoid was submitted with a more distributed and uniform load, preventing localized bone damage as a crush.
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Affiliation(s)
- Guilherme Augusto Stirma
- Federal University of São Paulo, Paulista School of Medicine - UNIFESP, São Paulo (SP), Brazil
- Corresponding author: Guilherme Augusto Stirma, MD, Federal University of São Paulo, Paulista School of Medicine - UNIFESP, Street Arruda Alvim, número 297, Ap 205, São Paulo, Brazil.
| | - Leandro Massini Ribeiro
- Federal University of São Paulo, Paulista School of Medicine - UNIFESP, São Paulo (SP), Brazil
| | | | - Paulo Santoro Belangero
- Federal University of São Paulo, Paulista School of Medicine - UNIFESP, São Paulo (SP), Brazil
| | | | | | - Carlos Vicente Andreoli
- Federal University of São Paulo, Paulista School of Medicine - UNIFESP, São Paulo (SP), Brazil
| | - Benno Ejnisman
- Federal University of São Paulo, Paulista School of Medicine - UNIFESP, São Paulo (SP), Brazil
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Hsu KL, Yeh ML, Kuan FC, Hong CK, Chuang HC, Wang WM, Su WR. Biomechanical comparison between various screw fixation angles for Latarjet procedure: a cadaveric biomechanical study. J Shoulder Elbow Surg 2022; 31:1947-1956. [PMID: 35398164 DOI: 10.1016/j.jse.2022.02.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latarjet procedure is a reliable treatment for the management of anterior glenohumeral instability with glenoid bone loss. However, the biomechanical properties of different fixation angles between screw and glenoid surface (α angle) have rarely been studied. The aim of the study was to investigate and compare the fixation stability, failure load, and failure mechanism between different α angles for Latarjet procedures, which were performed on cadaver specimens. METHODS Twenty-four shoulder specimens (8 in each of 3 groups) were dissected free of all soft tissue, and a 25% glenoid defect was created. The coracoid process was osteomized and fixed with 2 screws at 3 different α angles: 0° (group A), 15° (group B), and 30° (group C). Specimens were mounted to a testing apparatus, and cyclic loading (100 cycles at 1 Hz) was applied with a staircase protocol (50, 100, 150, and 200 N). Gross graft displacement and interface displacement were measured. The ultimate failure loads and failure mechanisms were recorded. RESULTS There was no significant difference in gross displacement under any cyclic load between 3 groups. However, a significant larger interface displacement was noted in group C than in group A in 150-N cyclic loading (P = .017). Under failure strength testing, all 24 specimens failed because of screw cutout from the glenoid, and the ultimate failure load was similar among the three groups. CONCLUSION Compared with the 0° α angle, the displacement after cyclic loading did not significantly increase when the α angle was increased to 15° but significantly increased at 30° for Latarjet procedures, which were performed on cadaver specimens. The results suggest that surgeons should apply the screws as parallel as possible to the glenoid surface when performing the Latarjet procedure. Although mild deviation may not reduce fixation stability, α angles greater than 30° should be avoided.
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Affiliation(s)
- Kai-Lan Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ming Wang
- Department of Statistics and Institute of Data Science, College of Management, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Parada SA, Shaw KA, McGee-Lawrence ME, Kyrkos JG, Paré DW, Amero J, Going JW, Morpeth B, Shelley R, Eichinger JK, Provencher MT. Anterior Glenoid Reconstruction With Distal Tibial Allograft: Biomechanical Impact of Fixation and Presence of a Retained Lateral Cortex. Orthop J Sports Med 2021; 9:23259671211050435. [PMID: 34778476 PMCID: PMC8581783 DOI: 10.1177/23259671211050435] [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: 06/16/2021] [Accepted: 07/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Glenoid reconstruction with distal tibial allograft (DTA) is a known surgical option for treating recurrent glenohumeral instability with anterior glenoid bone loss; however, biomechanical analysis has yet to determine how graft variability and fixation options alter the torque of screw insertion and load to failure. Hypothesis: It was hypothesized that retention of the lateral cortex of the DTA graft and the presence of a washer with the screw will significantly increase the maximum screw placement torque as well as the load to failure. Study Design: Controlled laboratory study. Methods: Whole, fresh distal tibias were used to harvest 28 DTA grafts, half of which had the lateral cortex removed and half of which had the lateral cortex intact. The grafts were secured to polyurethane solid foam blocks with a 2-mm epoxy laminate to simulate a glenoid with an intact posterior glenoid cortex. Grafts underwent fixation with 4.0-mm cannulated drills, and screws and washers were used for half of each group of grafts while screws alone were used for the other half, creating 4 equal groups of 7 samples each. A digital torque-measuring screwdriver recorded peak torque for screw insertion. Constructs were then tested in compression with a uniaxial materials testing system and loaded in displacement control at 100 mm/min until at least 3 mm of displacement occurred. Ultimate load was defined as the load sustained at clinical failure. Results: The use of a washer significantly improved the ultimate torque that could be applied to the screws (+cortex and +washer = 12.42 N·m [SE, 0.82]; –cortex and +washer = 10.54 N·m [SE, 0.59]) (P < .0001), whereas the presence of the native bone cortex did not have a significant effect (+cortex and –washer = 7.83 N·m [SE, 0.40]; –cortex and –washer = 8.03 N·m [SE, 0.56]) (P = .181). Conclusion: In a hybrid construct of fresh cadaveric DTA grafts secured to a foam block glenoid model, the addition of washers was more effective than the retention of the lateral distal tibial cortex for both load to failure and peak torque during screw insertion. Clinical Relevance: This biomechanical study is relevant to the surgeon when choosing a graft and selecting fixation options during glenoid reconstruction with a DTA graft.
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Affiliation(s)
- Stephen A Parada
- Department of Orthopaedics, Augusta University Medical Center, Augusta, Georgia, USA
| | - K Aaron Shaw
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Augusta, Georgia, USA
| | - Meghan E McGee-Lawrence
- Department of Cellular Biology and Anatomy, Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Judith G Kyrkos
- Department of Public Health at Augusta University, Augusta, Georgia, USA
| | - Daniel W Paré
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jessica Amero
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - James W Going
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Brice Morpeth
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Robert Shelley
- Department of Orthopaedics, Augusta University Medical Center, Augusta, Georgia, USA
| | - Josef K Eichinger
- Medical University of South Carolina, Charleston, South Carolina, USA
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