Concurrent Primary Repair of a Glenoid Labrum Articular Disruption and a Bankart Lesion in an Adolescent: A Case Report of a Novel Technique

Glenoid labrum articular disruption (GLAD) lesions are an uncommon concomitant injury associated with labral tears, occurring in 1.5-2.9% of cases. In previous reported cases, the articular lesion is debrided during repair of the labral injury, which may predispose patients to osteoarthritis, a longitudinal complication seen in articular debridement of the hip. We report the case of a 15-year-old healthy adolescent male swimmer who sustained a labral injury with a concomitant GLAD lesion. During operative management, three Polyetheretherketone (PEEK) SutureTaks were placed on the glenoid. #2 FiberWire was used to imbricate capsular tissue, passed beneath the labrum, and was then subsequently advanced through the fibrous rim of the displaced cartilage flap/GLAD lesion at the site of each suture anchor. This construct restored tension to the anterior band of the inferior glenohumeral ligament, recreated the anteroinferior labral bumper, and effectively reduced the cartilage flap/GLAD lesion to the anterior inferior glenoid. By six months postoperatively, the patient demonstrated near-normal function with full range of motion and evidence of a stable construct on MRI. Unlike previously described cases, this is the first report of a hybrid technique that simultaneously performed a primary repair of both labral and articular injuries without the use of additional implants for the articular lesion. Primary repair of the labral and articular lesions should provide longitudinal benefit to the patient by reducing the risk of developing glenohumeral osteoarthritis.

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Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120969640 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712096964

Author(s):

Sumit Raniga ◽

Joseph Cadman ◽

Danè Dabirrahmani ◽

David Bui ◽

Richard Appleyard ◽

...

Keyword(s):

Range Of Motion ◽

Biomechanical Study ◽

Labral Repair ◽

Pullout Strength ◽

Recurrent Instability ◽

Glenohumeral Ligament ◽

Time Zero ◽

Capsular Plication ◽

Inferior Glenohumeral Ligament ◽

The Impact

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability. Purpose/Hypothesis: A cadaveric biomechanical study was designed to investigate the suture pullout strength of sutures in the IGHL. We hypothesized that there would be no significant variability of suture pullout strength between specimens and zones. Additionally, we sought to determine the impact of early mobilization on sutures in the IGHL at time zero. We hypothesized that capsular plication sutures would fail under low load. Study Design: Descriptive laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were dissected to isolate the IGHL complex, which was then divided into 18 zones. Sutures in these zones were attached to a linear actuator, and the resistance to suture pullout was recorded. A suture pullout strength map of the IGHL was constructed. These loads were used to calculate the load applied at the hand that would initiate suture pullout in the IGHL. Results: Mean suture pullout strength for all specimens was 61.6 ± 26.1 N. The maximum load found to cause suture pullout through tissue was found to be low, regardless of zone of the IGHL. Calculations suggest that an external rotation force applied to the hand of only 9.6 N may be sufficient to tear capsular sutures at time zero. Conclusion: This study did not provide clear evidence of desirable locations for fixation in the IGHL. However, given the low magnitude of failure loads, the results suggest the timetable for initiation of range-of-motion exercises should be reconsidered to prevent suture pullout through the IGHL. Clinical Relevance: From this biomechanical study, the magnitude of force required to cause suture pullout through the IGHL is met or surpassed by normal postoperative early range-of-motion protocols.

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The effects of laser-induced collagen shortening on the biomechanical properties of the inferior glenohumeral ligament complex

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/s0749-8063(97)90069-4 ◽

1997 ◽

Vol 13 (3) ◽

pp. 390-391

Keyword(s):

Biomechanical Properties ◽

Glenohumeral Ligament ◽

Inferior Glenohumeral Ligament

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Development of a Finite Element Model of the Inferior Glenohumeral Ligament of the Glenohumeral Joint

Advances in Bioengineering ◽

10.1115/imece2003-43137 ◽

2003 ◽

Cited By ~ 1

Author(s):

William J. Newman ◽

Richard E. Debski ◽

Susan M. Moore ◽

Jeffrey A. Weiss

Keyword(s):

Finite Element ◽

Glenohumeral Joint ◽

External Rotation ◽

Element Model ◽

Fe Modeling ◽

Glenohumeral Ligament ◽

Subject Specific ◽

Inferior Glenohumeral Ligament ◽

Glenohumeral Capsule ◽

Shoulder Stability

The shoulder is one of the most complex and often injured joints in the human body. The inferior glenohumeral ligament (IGHL), composed of the anterior band (AB), posterior band (PB) and the axillary pouch, has been shown to be an important contributor to anterior shoulder stability (Turkel, 1981). Injuries to the IGHL of the glenohumeral capsule are especially difficult to diagnose and treat effectively. The objective of this research was to develop a methodology for subject-specific finite element (FE) modeling of the ligamentous structures of the glenohumeral joint, specifically the IGHL, and to determine how changes in material properties affect predicted strains in the IGHL at 60° of external rotation. Using the techniques developed in this research, an improved understanding of the contribution of the IGHL to shoulder stability can be acquired.

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Mini-open Repair of the Floating Anterior Inferior Glenohumeral Ligament: Combined Treatment of Bankart and Humeral Avulsion of the Glenohumeral Ligament Lesions

Arthroscopy Techniques ◽

10.1016/j.eats.2018.08.015 ◽

2018 ◽

Vol 7 (12) ◽

pp. e1281-e1287 ◽

Cited By ~ 1

Author(s):

Zachary S. Aman ◽

Mitchell I. Kennedy ◽

Anthony Sanchez ◽

Joseph J. Krob ◽

Colin P. Murphy ◽

...

Keyword(s):

Open Repair ◽

Combined Treatment ◽

Glenohumeral Ligament ◽

Inferior Glenohumeral Ligament ◽

Mini Open

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Quadriceps reconstruction with suture anchor and Achilles allograft combination in quadriceps tendon re-rupture after primary surgical repair: A novel technique

Joint Diseases and Related Surgery ◽

10.52312/jdrs.2021.14 ◽

2021 ◽

Author(s):

Erhan Okay ◽

Mehmet Cenk Turgut ◽

Abbas Tokyay

Keyword(s):

Suture Anchor ◽

Surgical Repair ◽

Primary Repair ◽

Full Range ◽

Knee Extensor ◽

Quadriceps Tendon ◽

Extensor Mechanism ◽

Surgical Options ◽

Knee Extensor Mechanism

Quadriceps ruptures are one of the pathological conditions of the knee extensor mechanism, accounting for 3% of all tendon injuries. These injuries cause substantial disability of the extensor mechanism. Primary repair is the treatment of choice in acute presentation. In the setting of chronic conditions, the treatment becomes more challenging. Available surgical options include lengthening procedures, and reconstruction with auto graft or allografts. The traditional Scuderi and Codivilla techniques are challenging to perform in degenerative or traumatic retracted ruptures. There is no standard effective treatment in these patients, which yields the best clinical and biomechanical outcomes. An 18 - year-old male patient with quadriceps re-rupture after a primary repair was managed with allograft reconstruction using suture anchors. At six years of follow-up, the patient gained a full range of motion with excellent clinical outcomes. He returned to his previous work. In conclusion, quadriceps reconstruction using suture anchor and Achilles allograft combination is a feasible technique in neglected cases who present with quadriceps tendon re-rupture after primary surgical repair.

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Biomechanical properties of the anterior band of the inferior glenohumeral ligament under stress

Acta Ortopédica Brasileira ◽

10.1590/s1413-78522003000200002 ◽

2003 ◽

Vol 11 (2) ◽

pp. 72-78

Author(s):

José Atualpa Pinheiro Júnior ◽

José Alberto Dias Leite ◽

Francisco Erivan de Abreu Melo ◽

José de Sá Cavalcante Júnior ◽

Antônio Cantídio Silva Campos ◽

...

Keyword(s):

Biomechanical Properties ◽

Force Constants ◽

Stress Strain ◽

Hooke’S Law ◽

Glenohumeral Ligament ◽

Group I ◽

Hooke's Law ◽

Inferior Glenohumeral Ligament ◽

Group Ii

This paper is aimed at studying the behavior of the band of inferior glenohumeral ligament subjected to uniaxial traction. Twenty ligaments were distributed in two groups: Group I ( ligaments with bony origin and insertion) and Group II ( medial portion of the ligament). Uniaxial traction was applied to all tendons utilizing a traction machine develop in the Department of Physics of UFC. Hooke's Law was used for evaluation of ligament behavior during elastic phase and the Exponential stress-strain Law, for rigidity phase. All ligaments had the same behavior, presenting a phase of elasticity , followed by one of rigidity. After evaluation of the elastic phase , applying Hooke's Law, ligaments constants were 10.507 N/mm ( group I ) and 13.80 N/mm ( group II), suffering a straining of 2.83% and 2.84%,respectively, until the ligament became rigid. During rigidity phase, the constants were 511.56% N/mm (group I) and 156.84% N/mm (group II). It is concluded that the ligament submitted to traction suffers a small elongation until becoming rigid along with an important increase in force constants during rigidity phase.

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Inferior Glenohumeral Ligament (IGHL) Injuries: A Case Series of Magnetic Resonance (MR) Imaging Findings and Arthroscopic Correlation

Kansas Journal of Medicine ◽

10.17161/kjm.vol13.13546 ◽

2020 ◽

Vol 13 ◽

pp. 275-279

Author(s):

Michael Glass ◽

Vafa Behzadpour ◽

Jessica Peterson ◽

Lauren Clark ◽

Shelby Bell-Glenn ◽

...

Keyword(s):

Magnetic Resonance ◽

Case Series ◽

Inclusion Criteria ◽

Glenohumeral Ligament ◽

Radiology Reports ◽

Labral Tears ◽

Tissue Edema ◽

Cortical Irregularity ◽

Inferior Glenohumeral Ligament ◽

Magnetic Resonance Imaging Mri

The inferior glenohumeral ligament (IGHL) complex is commonly assessed by both magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrogram. Our study aimed to compare the accuracy of MR arthrogram compared to MRI using arthroscopic correlation as the gold standard. A retrospective review of cases reporting an IGHL injury was performed. 77 cases met inclusion criteria, while 5 had arthroscopic reports that directly confirmed or refuted the presence of IGHL injury. Two arthroscopic reports confirmed concordant IGHL injuries, while 3 arthroscopic reports mentioned discordant findings compared to MR. Interestingly, all three discordant cases involved MR arthrogram. Findings included soft tissue edema, fraying of the axillary pouch fibers, and cortical irregularity of the humeral neck. Of the two concordant cases, one was diagnosed by MRI, revealing an avulsion of the anterior band, while the second was diagnosed by MR arthrogram showing ill-defined anterior band fibers. Many cases involved rotator cuff or labral tears, which may have been the focus of care for providers, given their importance for shoulder stability. Additionally, a lack of diagnostic confidence in MR reports may have influenced surgeons in the degree to which they assessed the IGHL complex during arthroscopy. In conclusion, radiologists seemed more likely to make note of IGHL injuries when MR arthrograms were performed; meanwhile, all three discordant cases involved MR arthrogram reads. Therefore, additional larger studies are needed with arthroscopic correlation to better elucidate MR findings that confidently suggest injury to the IGHL complex, in order to avoid false positive radiology reports.

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Imaging of the Shoulder Bankart Lesion and its Variants

Nepalese Journal of Radiology ◽

10.3126/njr.v9i1.24816 ◽

2019 ◽

Vol 9 (1) ◽

pp. 33-39

Author(s):

Kheng Song Leow ◽

Soo Fin Low ◽

Wilfred CG Peh

Keyword(s):

Imaging Modality ◽

Imaging Techniques ◽

Mr Arthrography ◽

Recurrent Dislocation ◽

Tissue Structure ◽

Bankart Lesion ◽

Glenoid Labrum ◽

Labral Tears ◽

Chronic Shoulder Instability ◽

Labral Injury

The glenoid labrum is an important soft tissue structure that provides stability to the shoulder joint. When the labrum is injured, affected patients may present with chronic shoulder instability and future recurrent dislocation. The Bankart lesion is the most common labral injury, and is often accompanied by a Hill-Sachs lesion of the humerus. Various imaging techniques are available for detection of the Bankart lesion and its variants, such as anterior labroligamentous periosteal sleeve avulsion and Perthes lesion. Direct magnetic resonance (MR) arthrography is currently the imaging modality of choice for evaluation of the various types of labral tears. As normal anatomical variants of glenoid labrum are not uncommonly encountered, familiarity with appearances of this potential pitfall helps avoid misdiagnosis.

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Collagen Fiber Alignment and Maximum Principal Strain in the Glenohumeral Capsule Predict Location of Failure During Uniaxial Extension

ASME 2011 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2011-53492 ◽

2011 ◽

Author(s):

Kelvin Luu ◽

Carrie A. Voycheck ◽

Patrick J. McMahon ◽

Richard E. Debski

Keyword(s):

Collagen Fiber ◽

Glenohumeral Joint ◽

Uniaxial Extension ◽

Principal Strain ◽

Fiber Alignment ◽

Glenohumeral Ligament ◽

Maximum Principal Strain ◽

Inferior Glenohumeral Ligament ◽

Glenohumeral Capsule ◽

Collagen Fiber Alignment

The glenohumeral joint is frequently dislocated causing injury to the glenohumeral capsule (axillary pouch (AP), anterior band of the inferior glenohumeral ligament (AB-IGHL), posterior band of the inferior glenohumeral ligament (PB-IGHL), posterior (Post), and anterosuperior region (AS)). [1, 2] The capsule is a passive stabilizer to the glenohumeral joint and primarily functions to resist dislocation during extreme ranges of motion. [3] When unloaded, the capsule consists of randomly oriented collagen fibers, which play a pertinent role in its function to resist loading in multiple directions. [4] The location of failure in only the axillary pouch has been shown to correspond with the highest degree of collagen fiber orientation and maximum principle strain just prior to failure. [4, 5] However, several discrepancies were found when comparing the collagen fiber alignment between the AB-IGHL, AP, and PB-IGHL. [3,6,7] Therefore, the objective was to determine the collagen fiber alignment and maximum principal strain in five regions of the capsule during uniaxial extension to failure and to determine if these parameters could predict the location of tissue failure. Since the capsule functions as a continuous sheet, we hypothesized that maximum principal strain and peak collagen fiber alignment would correspond with the location of tissue failure in all regions of the glenohumeral capsule.

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