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Oenning S, Wermers J, Taenzler S, Michel PA, Raschke MJ, Christoph Katthagen J. Glenoid Concavity Affects Anterior Shoulder Stability in an Active-Assisted Biomechanical Model. Orthop J Sports Med 2024; 12:23259671241253836. [PMID: 38881852 PMCID: PMC11179473 DOI: 10.1177/23259671241253836] [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: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 06/18/2024] Open
Abstract
Background The treatment of bony glenoid defects after anteroinferior shoulder dislocation currently depends on the amount of glenoid bone loss (GBL). Recent studies have described the glenoid concavity as an essential factor for glenohumeral stability. The role of glenoid concavity in the presence of soft tissue and muscle forces is still unknown. Hypothesis Glenoid concavity would have a major impact on glenohumeral stability in an active-assisted biomechanical model including soft tissue and the rotator cuff's compression forces. Study Design Controlled laboratory study. Methods In 8 human shoulder specimens, individual coordinate systems were calculated based on anatomic landmarks. The glenoid concavity was measured biomechanically and based on computed tomography. Static load was applied to the rotator cuff tendons and the deltoid muscle. In a robotic test setup, anteriorly directed force was applied to the humeral head until translation of 5 mm (Nant) was achieved. Nant was used as a parameter indicating shoulder stability. This was performed in the following testing stages: (1) intact joint, (2) labral lesion, (3) 10% GBL, and (4) 20% GBL. The 8 specimens were divided equally into 2 subgroups (low concavity [LC] versus high concavity [HC]), with 4 specimens each, according to the previously measured concavity. Results Anterior glenohumeral stability was highly correlated with the native glenoid concavity (R 2 = 0.8). In the testing stages 1 to 3, we found a significantly higher mean stability in the HC subgroup compared with the LC subgroup (P≤ .0142). The HC subgroup still showed higher absolute Nant values with 20% GBL; however, there was no significant difference from the LC subgroup. The loss of stability in 20% GBL was correlated with the initial concavity (R 2 = 0.86). Thus, a higher loss of Nant in the HC subgroup was observed (P = .0049). Conclusion In an active-assisted model with intact soft tissue surrounding and muscular compression forces, the glenoid concavity correlates with shoulder stability. In bony defects, loss of concavity is an essential factor causing instability. Due to their significantly higher native stability, glenoids with HC can tolerate a higher amount of GBL. Clinical Relevance Glenoid concavity should be considered in an individualized treatment of bony glenoid defects. Further studies are required to establish reference values and develop therapeutic algorithms.
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Affiliation(s)
- Sebastian Oenning
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Jens Wermers
- Faculty of Engineering Physics, FH Muenster, Muenster, Germany
| | - Stefanie Taenzler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Philipp A Michel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - J Christoph Katthagen
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
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Karpinski K, Akguen D, Gebauer H, Paksoy A, Lupetti M, Markova V, Zettinig O, Moroder P. Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability. Orthop J Sports Med 2024; 12:23259671231222938. [PMID: 38352173 PMCID: PMC10863483 DOI: 10.1177/23259671231222938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 02/16/2024] Open
Abstract
Background The presence of glenoid bone defects is indicative in the choice of treatment for patients with anterior shoulder instability. In contrast to traditional linear- and area-based measurements, techniques such as the consideration of glenoid concavity have been proposed and validated. Purpose To compare the reliability of linear (1-dimensional [1D]), area (2-dimensional [2D]), and concavity (3-dimensional [3D]) measurements to quantify glenoid bone loss performed manually and to analyze how automated measurements affect reliability. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Computed tomography images of 100 patients treated for anterior shoulder instability with differently sized glenoid defects were evaluated independently by 2 orthopaedic surgeons manually using conventional software (OsiriX; Pixmeo) as well as automatically with a dedicated prototype software program (ImFusion Suite; ImFusion). Parameters obtained included 1D (defect diameter, best-fit circle diameter), 2D (defect area, best-fit circle area), and 3D (bony shoulder stability ratio) measurements. Mean values and reliability as expressed by the intraclass correlation coefficient [ICC]) were compared between the manual and automated measurements. Results When manually obtained, the measurements showed almost perfect agreement for 1D parameters (ICC = 0.83), substantial agreement for 2D parameters (ICC = 0.79), and moderate agreement for the 3D parameter (ICC = 0.48). When measurements were aided by automated software, the agreement between raters was almost perfect for all parameters (ICC = 0.90 for 1D, 2D, and 3D). There was a significant difference in mean values between manually versus automatically obtained measurements for 1D, 2D, and 3D parameters (P < .001 for all). Conclusion While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, our study showed that the reliability of manually performed, more complex measurements was moderate.
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Affiliation(s)
- Katrin Karpinski
- Centrum für Muskuloskeletale Chirurgie, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Doruk Akguen
- Centrum für Muskuloskeletale Chirurgie, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Henry Gebauer
- Centrum für Muskuloskeletale Chirurgie, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Alp Paksoy
- Centrum für Muskuloskeletale Chirurgie, Charité–Universitätsmedizin Berlin, Berlin, Germany
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Lau LCM, Chau WW, Ng R, Ng JP, Chui ECS, Ong MTY, Griffith JF, Yung PSH. Reconsidering "Critical" Bone Loss in Shoulder Instability: 17-Year Follow-Up Study following Arthroscopic Bankart Repair. Adv Orthop 2024; 2024:5598107. [PMID: 38328468 PMCID: PMC10849799 DOI: 10.1155/2024/5598107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/30/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Background Glenoid bone loss is a risk factor leading to the failure of arthroscopic Bankart repair. While 20-25% glenoid bone loss has long been considered the level to necessitate bony augmentation, recent studies indicate that 13.5% has a "subcritical" glenoid bone loss level, which is associated with decreased short- and medium-term functional scores. Few researchers worked on the long-term effect of "subcritical" or even less severe degrees of glenoid bone loss on redislocation rates and functional outcomes after arthroscopic Bankart repair. This study aimed to evaluate the effect of subcritical or less severe glenoid bone loss on redislocation rates and function after arthroscopic Bankart repair. Methods A patient cohort who had undergone computed tomography (CT) of glenoid bone loss and arthroscopic Bankart repair over 15 years ago was reviewed. Western Ontario Shoulder Instability (WOSI) score, Single Assessment Numeric Evaluation (SANE) score, redislocation after operation, mechanism of recurrence, and revision details were reviewed. Results Seventy-five patients were reassessed 17.6 ± 1.9 years following initial surgery. The age at enrolment was 26.8 ± 8.3 years. Twenty-two (29%) patients of the 75 patients had a redislocation on long-term follow-up, though this was not related to glenoid bone loss severity. The impaired functional score was found in patients with initial glenoid bone loss of 7% or more on long-term follow-up: WOSI (physical symptoms): 0.98 ± 2.00 vs 2.25 ± 4.01, p=0.04 and WOSI (total): 0.79 ± 1.43 vs 1.88 ± 3.56, p=0.04. Conclusions At a mean of 17.5 years following arthroscopic Bankart repair, redislocation occurs in over a quarter of 75 patients, and they are not related to initial glenoid bone loss severity. Impaired functional outcome is apparent in patients with initial glenoid bone loss of >7%, though this impairment does not seem sufficiently severe to warrant an alternative treatment approach.
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Affiliation(s)
- Lawrence Chun-Man Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wai-Wang Chau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Randy Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jonathan Patrick Ng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Elvis Chun-Sing Chui
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Michael Tim-Yun Ong
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Park I, Shin SJ. Correlation of Glenoid Concavity With Surgical Failure After Arthroscopic Stabilization for Recurrent Anterior Shoulder Instability. Am J Sports Med 2023; 51:3845-3850. [PMID: 37853648 DOI: 10.1177/03635465231203152] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND Glenoid concavity compression by rotator cuff muscle contraction is one of the key mechanisms in the stability of the glenohumeral joint. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the effects of glenoid concavity, as represented by the bony shoulder stability ratio (BSSR) and other factors, including glenoid bone defect size, on the surgical failure of arthroscopic stabilization procedures for recurrent anterior shoulder instability. The authors also aimed to determine the critical value of BSSR. It was hypothesized that both glenoid concavity and glenoid bone defect size would be correlated with surgical failure, with glenoid concavity having a stronger correlation. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 120 patients who underwent arthroscopic stabilization procedures for recurrent anterior shoulder instability were included. Patients with bony Bankart lesions were excluded to eliminate the postoperative effects of bony fragment restoration on the glenoid concavity. For each patient, variable factors including BSSR, glenoid bone defect size, presence of off-track Hill-Sachs lesions, and age at first dislocation were recorded. Chi-square analysis and Student t test were performed to analyze the effect of each variable on surgical failure. Multivariate logistic regression analysis was used to determine the combined effect of >2 variables on surgical failure. The critical value of BSSR was analyzed using a receiver operating characteristic curve. RESULTS Nine patients (7.5%) had recurrent instability requiring revision surgery. BSSR (patients with recurrence, 18.6% ± 19.4%; patients without recurrence, 41.8% ± 10.5%; P = .01), glenoid bone defect size (17.5% ± 3.6% vs 11.7% ± 7.0%; P = .02), age at the time of first dislocation (18.8 ± 3.9 years vs 22.0 ± 6.5 years; P = .04), and number of suture anchors used (4.1 ± 0.3 vs 5.8 ± 1.6; P < .001) showed significant differences between patients with and without surgical failure. Multivariate logistic regression analysis revealed surgical failure to be correlated with BSSR (odds ratio, 0.849; P = .02) and the number of suture anchors used (odds ratio, 0.070; P = .03). The critical value of BSSR was 29.3% (area under the curve, 0.84; 95% CI, 0.67-1.00; P < .001; sensitivity, 78%; specificity, 93%). CONCLUSION Glenoid concavity is strongly correlated with surgical failure after arthroscopic stabilization procedures for anterior shoulder instability. The value of BSSR reflects shoulder instability caused by glenoid bone morphology more accurately than glenoid bone defect size.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
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Wu C, Liu B, Xu C, Zhao S, Li Y, Xu J, Zhao J. Native Glenoid Depth and Hill-Sachs Lesion Morphology in Traumatic Anterior Shoulder Instability. Am J Sports Med 2023; 51:3374-3382. [PMID: 37740546 DOI: 10.1177/03635465231200246] [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] [Indexed: 09/24/2023]
Abstract
BACKGROUND Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid concavity influences HSL morphology. PURPOSE To investigate the relationship between the native glenoid depth and HSL morphological characteristics. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Computed tomography images of bilateral shoulders from 151 consecutive patients with traumatic unilateral anterior shoulder instability were retrospectively reviewed. Patients were categorized into flat (<1 mm), moderate (1-2 mm), and deep (>2 mm) groups based on the native glenoid depth measured from the contralateral unaffected shoulder. The HSL morphological characteristics included size (depth, width, length, and volume), location (medial, superior, and inferior extent), and orientation (rim and center angle). The glenoid characteristics included diameter, depth, version, and bone loss. The patient, glenoid, and HSL morphological characteristics were compared among the 3 depth groups. Subsequently, the independent predictors of some critical HSL morphological characteristics were determined using multivariate stepwise regression. RESULTS After exclusion of 55 patients, a total of 96 patients were enrolled and classified into the flat group (n = 31), moderate group (n = 35), and deep group (n = 30). Compared with those in the flat group, patients in the deep group were more likely to have dislocation (38.7% vs 93.3%; P = .009) at the primary instability and had a significantly larger number of dislocations (1.1 ± 1.0 vs 2.2 ± 1.8; P = .010); moreover, patients in the deep group had significantly deeper, wider, larger volume, more medialized HSLs and higher incidences of off-track HSLs (all P≤ .025). No significant differences were detected among the 3 groups in HSL length, vertical position, and orientation (all P≥ .064). After adjustment for various radiological and patient factors in the multivariate regression model, native glenoid depth remained the strongest independent predictor for HSL depth (β = 0.346; P < .001), width (β = 0.262; P = .009), volume (β = 0.331; P = .001), and medialization (β = -0.297; P = .003). CONCLUSION The current study sheds light on the association between native glenoid depth and the morphology of HSLs in traumatic anterior shoulder instability. Native glenoid depth was independently and positively associated with HSL depth, width, volume, and medialization. Patients with deeper native glenoids were more likely to have off-track HSLs and thus require more attention in the process of diagnosis and treatment.
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Affiliation(s)
- Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Beibei Liu
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kıvrak A, Ulusoy İ. Effect of Glenohumeral Joint Bone Morphology on Anterior Shoulder Instability: A Case-Control Study. J Clin Med 2023; 12:4910. [PMID: 37568312 PMCID: PMC10419457 DOI: 10.3390/jcm12154910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Glenohumeral joint compatibility and bone morphology are among the most critical factors in shoulder stabilization. Our study investigated the effect of the bone morphological structure of the shoulder joint on anterior shoulder dislocation. METHODS In our study, people with a history of shoulder dislocation were selected as the patient group. In the control group, patients with shoulder MRIs for any reason and no history of shoulder dislocation were included. Those who have a fracture around the shoulder, a congenital deformity in the shoulder region, arthrosis of the shoulder, those whose MRI images cannot be measured, those with Hill-Sachs lesion, connective tissue diseases (such as Ehler Danlos), who are unsure of their diagnosis, or who have incomplete and incorrect suspicious information in their patient file have been excluded. In our retrospective case-control study, glenoid width, glenoid height, glenoid's height-to-width ratio, glenoid's depth, glenoid's version, glenoid's inclination, humerus radius of curvature, glenoid radius of curvature, and bony shoulder stability ratio were measured on MRI images of the patients. The sample size for each group was determined using a power analysis method. The intra-class coefficient (ICC) assessed interobserver and intraobserver reliability. RESULTS A total of 80 patients, 40 each in the control and patient groups, were included in the study. Glenoid width was measured as 24.27 ± 1.58 in the patient group, 25.61 ± 1.72 in the control group; glenoid height was as measured 36.49 ± 2.26 in the patient group, 36.74 ± 1.99 in the control group; height-to-width ratio was measured as 1.5 ± 0.08 in the patient group, 1.43 ± 0.05 in the control group; glenoid version was as measured -0.53 ± 1.17 in the patient group, -1.44 ± 1.1 in the control group; glenoid inclination was measured as 1.44 ± 3.93 patient group, 2.64 ± 3.81 in the control group; glenoid depth was measured as 1.69 ± 0.41 in the patient group, 2.12 ± 0.53 in the control group; humerus radius of curvature was measured as 29.70 ± 6.76 in the patient group, 24.98 ± 3.22 in the control group; glenoid axial radius of curvature was measured as 61.8 ± 13.52 in the patient group, 52.53 ± 15.69 in the control group; glenoid coronal radius of curvature was measured as 43.01 ± 7.47 in the patient group, 37.74 ± 6.89 in the control group; the bony shoulder stability ratio was measured as 0.35 ± 0.06 in the patient group and 0.44 ± 0.06 in the control group. In the statistical evaluation, the glenoid width (p < 0.001), the glenoid height/width ratio (p < 0.001), the glenoid version (p < 0.001), the depth of the glenoid cavity (p < 0.001), and the radius of curvature measurements of the humeral head (p < 0.001) and the glenoid (axial, p < 0.007; coronal, p < 0.001) were found to be significantly different. Glenoid height and inclination were similar in both groups. CONCLUSIONS The detection of bone morphological features that constitute risk factors for shoulder dislocations plays an important role in preventing shoulder dislocations. In this way, it provides essential data on personalized rehabilitation programs and treatment selection for recurrent dislocations.
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Affiliation(s)
| | - İbrahim Ulusoy
- Department of Orthopedic Surgery, Selahhadin Eyyubi State Hospital, 21100 Diyarbakır, Turkey
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Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3626-3633. [PMID: 35434767 PMCID: PMC9568486 DOI: 10.1007/s00167-022-06968-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Glenohumeral joint injuries frequently result in shoulder instability. However, the biomechanical effect of cartilage loss on shoulder stability remains unknown. The aim of the current study was to investigate biomechanically the effect of two severity stages of cartilage loss in different dislocation directions on shoulder stability. METHODS Joint dislocation was provoked in 11 human cadaveric glenoids for 7 different directions between 3 o'clock (anterior) and 9 o'clock (posterior). Shoulder stability ratio (SSR) and concavity gradient were assessed in three states: intact, 3 mm and 6 mm simulated cartilage loss. The influence of cartilage loss on SSR and concavity gradient was statistically evaluated. RESULTS Both SSR and concavity gradient decreased significantly between intact state and 6 mm cartilage loss in every dislocation direction (p ≤ 0.038), except concavity gradient in 4 o'clock direction. Thereby, anterior-inferior dislocation directions were associated with the highest decrease in both SSR and concavity gradient of up to 59.0% and 49.4%, respectively, being significantly bigger for SSR compared with all other dislocation directions (p ≤ 0.040). Correlations between concavity gradient and SSR for pooled dislocation directions were significant in each separate specimen's state (p < 0.001). CONCLUSION From a biomechanical perspective, articular cartilage of the glenoid contributes significantly to the concavity gradient, correlating strongly with the associated loss in glenohumeral joint stability. The biggest effect of cartilage loss is observed in the most frequently occurring anterior-inferior dislocation directions, suggesting that surgical interventions to restore cartilage's surface and concavity should be considered for recurrent shoulder dislocations in presence of cartilage loss.
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