scholarly journals Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect

2021 ◽  
Author(s):  
Jens Wermers ◽  
Benedikt Schliemann ◽  
Michael J. Raschke ◽  
Philipp A. Michel ◽  
Lukas F. Heilmann ◽  
...  
Keyword(s):  
Bone Loss ◽  
Linear Model ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Bony Defect ◽  
Stability Ratio ◽  
Anterior Glenoid ◽  
Shoulder Stability

Abstract Purpose Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. Methods The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. Results Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. Conclusion Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.

Challenging the Current Concept of Critical Glenoid Bone Loss in Shoulder Instability: Does the Size Measurement Really Tell It All?

2019 ◽  
Vol 47 (3) ◽  
pp. 688-694 ◽  
Author(s):  
Philipp Moroder ◽  
Philipp Damm ◽  
Guido Wierer ◽  
Elisabeth Böhm ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Measurement Techniques ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Glenoid Defect ◽  
Element Analysis ◽  
Anterior Glenoid ◽  
Biomechanical Effect

Background: Bone loss at the anterior glenoid rim is a main reason for failure of soft-tissue based surgical stabilization procedures in patients with anterior shoulder instability. Purpose: To evaluate the capability of conventional glenoid bone loss measurement techniques to provide an adequate estimation of the actual biomechanical effect of glenoid defects. Study Design: Descriptive laboratory study. Methods: Thirty consecutive patients with unilateral anterior shoulder instability and varying degrees of glenoid defect were included. Patient-specific computer tomography–based 3-dimensional shoulder models of the affected and unaffected sides were created. The bony shoulder stability ratio (SR) was determined in various potential dislocation directions with finite element analysis. Values obtained from conventional glenoid defect size measurement techniques (Pico and Sugaya) were correlated with the finite element analysis results. Additionally, a mathematical model was developed to theoretically analyze the correlation between glenoid defect size measurements and the SR. Results: The authors found substantial interindividual differences of the SR of the unaffected shoulders in all directions of measurement. Bone loss at the anterior glenoid rim significantly reduced the SR in the 2-o’clock ( P = .011), 3-o’clock ( P < .001), and 4-o’clock ( P < .001) directions referring to a right shoulder. The correlation between the defect size measurements and the SR for the 2-o’clock (rho = −0.522 and −0.580), 3-o’clock (rho = −0.597 and −0.580), and 4-o’clock (rho = −0.527 and −0.522) directions was statistically significant. However, it showed only moderate strength and was nonlinear as well as dependent on the inherent shape of the concavity. As shown by the mathematical model, bone loss has the most considerable effect at the edge of the glenoid rim, and an increasingly concave-shaped glenoid leads to an increase in loss of SR provoked by the same extent of bone loss. Conclusion: Current glenoid bone loss measurements are unable to provide an adequate estimation on the actual biomechanical effect of glenoid defects because (1) the relation between the glenoid defect size and its biomechanical effect is nonlinear and (2) patients with shoulder instability have constitutional biomechanically relevant glenoid concavity shape differences. Clinical Relevance: These findings challenge the current concept of setting a general threshold for critical glenoid bone loss, which requires bony reconstruction surgery.

Arthroscopic Management of Anterior Glenoid Bone Loss

JBJS Reviews ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e0049
Author(s):  
Devin Lemmex ◽  
Gabriel Cárdenas ◽  
Matthew Ricks ◽  
Jarret Woodmass ◽  
Mikaël Chelli ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Arthroscopic Management ◽  
Anterior Glenoid

scholarly journals Effect of Anterior Glenoid Labral Tears and Glenoid Bone Loss at the NFL Combine on Future NFL Performance

2018 ◽  
Vol 6 (7) ◽  
pp. 232596711878488 ◽  
Author(s):  
Colin P. Murphy ◽  
Salvatore J. Frangiamore ◽  
Sandeep Mannava ◽  
Anthony Sanchez ◽  
Evan R. Beiter ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Labral Tears ◽  
Anterior Glenoid

A Flat Anterior Glenoid Corresponds to Subcritical Glenoid Bone Loss

2019 ◽  
Vol 35 (6) ◽  
pp. 1788-1793 ◽  
Author(s):  
Drew A. Lansdown ◽  
Kevin Wang ◽  
Adam B. Yanke ◽  
Gregory P. Nicholson ◽  
Brian J. Cole ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Anterior Glenoid

scholarly journals Arthroscopic Bristow-Latarjet Combined With Bankart Repair Restores Shoulder Stability in Patients With Glenoid Bone Loss

2014 ◽  
Vol 472 (8) ◽  
pp. 2413-2424 ◽  
Author(s):  
Pascal Boileau ◽  
Charles-Édouard Thélu ◽  
Numa Mercier ◽  
Xavier Ohl ◽  
Robert Houghton-Clemmey ◽  
...  
Keyword(s):  
Bone Loss ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Shoulder Stability

Accuracy of Currently Available Methods in Quantifying Anterior Glenoid Bone Loss: Controversy Regarding Gold Standard—A Systematic Review

2020 ◽  
Vol 36 (8) ◽  
pp. 2295-2313.e1 ◽  
Author(s):  
Lukas P.E. Verweij ◽  
Alexander A. Schuit ◽  
Gino M.M.J. Kerkhoffs ◽  
Leendert Blankevoort ◽  
Michel P.J. van den Bekerom ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Gold Standard ◽  
Glenoid Bone Loss ◽  
Anterior Glenoid

Critical Value of Anterior Glenoid Bone Loss That Leads to Recurrent Glenohumeral Instability After Arthroscopic Bankart Repair

2017 ◽  
Vol 45 (9) ◽  
pp. 1975-1981 ◽  
Author(s):  
Sang-Jin Shin ◽  
Rag Gyu Kim ◽  
Yoon Sang Jeon ◽  
Tae Hun Kwon
Keyword(s):  
Bone Loss ◽  
Critical Value ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Glenohumeral Instability ◽  
Anterior Glenoid ◽  
Group A ◽  
Surgical Failure ◽  
Group B ◽  
Glenoid Erosion

Background: Generally, a glenoid bone loss greater than 20% to 25% is considered critical for poor surgical outcomes after a soft tissue repair. However, recent studies have suggested that the critical value should be lower. Purpose: To determine the critical value of anterior glenoid bone loss that led to surgical failure in patients with anterior shoulder instability. Study Design: Case-control study; Level of evidence, 3. Methods: The study included 169 patients with anterior glenoid erosion. The percentage of glenoid erosion was calculated as the ratio of the glenoid loss width and the glenoid width to the diameter of the outer-fitting circle based on the inferior portion of the glenoid contour. The critical value of the glenoid bone loss was analyzed by means of receiver operating characteristic (ROC) curve analysis. Patients were divided into 2 groups based on the amount of glenoid bone loss: group A (less than the critical value) and group B (more than the critical value). Patients evaluated their shoulder function as a percentage of their preinjury level using the Single Assessment Numeric Evaluation (SANE) score, and postoperative clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score and Rowe score. Surgical failure was defined as the need for revision surgery or the presence of subjective symptoms of instability. Results: The optimal critical value of glenoid bone loss was 17.3% (area under the curve = 0.82; 95% confidence interval, 0.73-0.91; P < .001; sensitivity 75%; specificity 86.6%). Group A and B contained 134 and 35 patients, respectively. Shoulder functional scores were significantly lower in group B than in group A ( P < .001). Five patients (3.7%) in group A and 15 (42.9%) in group B had surgical failure ( P < .001). The SANE score was significantly lower in group B (83.8 ± 12.1) than in group A (92.9 ± 4.7, P = .001). Conclusion: An anterior glenoid bone loss of 17.3% or more with respect to the longest anteroposterior glenoid width should be considered as the critical amount of bone loss that may result in recurrent glenohumeral instability after arthroscopic Bankart repair.

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