scholarly journals The 6 O’Clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Steven L. Bokshan ◽  
Steven F. DeFroda ◽  
Joseph Gil ◽  
J.J. Trey Crisco ◽  
Brett D. Owens
Keyword(s):  
Bone Loss ◽  
Bone Defect ◽  
Suture Anchor ◽  
Peak Force ◽  
Bankart Lesion ◽  
Bankart Repair ◽  
Resistance Force ◽  
Loss Model ◽  
Anterior Glenoid ◽  
Peak Resistance

Objectives: Despite a growing body of literature regarding optimal repair configurations, little is known about inferior suture anchor placement (6 o’clock position). Here, we determine the biomechanical strength of adding a 6’oclock anchor to a “standard” Bankart repair in a normal glenoid and a 13% anterior bone loss model. Methods: 12 cadaveric shoulders were tested on a six axis industrial robot to measure the peak resistance to translation force with anterior displacement (1 centimeter). The rotator cuff muscles were loaded during testing to simulate physiological conditions. Test conditions included intact shoulder, Bankart lesion, Bankart repair (3, 4, and 5 o’clock anchors), and Bankart repair with a 6 o’clock anchor. A 13% anterior bone defect was then created (based on pretest CT scan) and all conditions were repeated. Repeated measures ANOVA was used to test for significant differences among groups. Results: In the no bone loss group, the addition of a 6 o’clock anchor yielded the highest peak resistance force (52.8 N, SD: 4.5 N) and was significantly stronger than the standard Bankart repair by 15.8% (7.2 N, p = 0.003). With 13% bone loss from the anterior glenoid, both the standard Bankart repair (peak force 49.3 N, SD: 6.1 N, p = 0.02) and repair with the addition of the 6 o’clock anchor (peak force 52.6 N, SD: 6.1 N, p = 0.006) had a significantly higher peak resistance force compared to the bone loss with Bankart lesion group (35.2 N, SD: 5.8 N). While the 6 o’clock anchor did increase the strength of the standard repair by 6.7%, this was not statistically significant (p = 0.9) in the bone loss model. Conclusion: The addition of a 6 o’clock suture anchor to a ”standard” Bankart repair increases to the peak resistance to translation force (no bone loss), although this additional strength is lost with creation of a 13% anterior glenoid bone defect.

scholarly journals Critical Glenoid Bone Loss in Posterior Shoulder Instability

2018 ◽  
Vol 46 (5) ◽  
pp. 1058-1063 ◽  
Author(s):  
Christopher Nacca ◽  
Joseph A. Gil ◽  
Rohit Badida ◽  
Joseph J. Crisco ◽  
Brett D. Owens
Keyword(s):  
Bone Loss ◽  
Lateral Displacement ◽  
Peak Force ◽  
Glenoid Bone Loss ◽  
Bankart Lesion ◽  
Bankart Repair ◽  
Labral Repair ◽  
Glenoid Defect ◽  
The Mean ◽  
Osseous Defect

Background: There is currently no consensus regarding the amount of posterior glenoid bone loss that is considered critical. Critical bone loss is defined as the amount of bone loss that occurs in which an isolated labral repair will not sufficiently restore stability. Purpose: The purpose is to identify the critical size of the posterior defect. Study Design: Controlled laboratory study. Methods: Eleven cadaveric shoulders were tested. With the use of a custom robot device, a 50-N compressive force was applied to the glenohumeral joint, and the peak force that was required to translate the humeral head posteriorly and the lateral displacement that occurred with translation were measured. The defect size was measured as a percentage of the glenoid width. Testing was performed in 11 conditions: (1) intact glenoid and labrum, (2) simulated reverse Bankart lesion, (3) the reverse Bankart lesion repaired, (4) a 10% defect, (5) the reverse Bankart lesion repaired, (6) a 20% defect, (7) the reverse Bankart lesion repaired, (8) a 30% defect, (9) the reverse Bankart lesion repaired, (10) a 40% defect, and (11) the reverse Bankart repaired. Results: Force and displacement decreased as the size of the osseous defect increased. The mean peak force that occurred with posterior displacement in specimens with a glenoid defect ≥20% and a reverse Bankart repair (13 ± 9 N) was significantly lower than the peak force that occurred in specimens with an isolated reverse Bankart repair (22 ± 10 N) ( P = .0451). In addition, the mean lateral displacement was significantly less in the specimens with a 20% glenoid defect and a reverse Bankart repair (0.61 ± 0.57 mm) compared with the lateral displacement that occurred in specimens with an isolated reverse Bankart repair (1.6 ± 0.78 mm) ( P = .0058). Conclusion: An osseous defect that is ≥20% of the posterior glenoid width remains unstable after isolated reverse Bankart repair. Clinical Relevance: A bony restoration procedure of the glenoid may be necessary in shoulders with a posterior glenoid defect that is ≥20% of the glenoid width.

scholarly journals Biomechanical Comparison of the Long Head of the Biceps Tendon Versus Conjoint Tendon Transfer in a Bone Loss Shoulder Instability Model

2019 ◽  
Vol 7 (11) ◽  
pp. 232596711988354
Author(s):  
Steven L. Bokshan ◽  
Joseph A. Gil ◽  
Steven F. DeFroda ◽  
Rohit Badida ◽  
Joseph J. Crisco ◽  
...  
Keyword(s):  
Bone Loss ◽  
Tendon Transfer ◽  
Biceps Tendon ◽  
Bankart Repair ◽  
Labral Repair ◽  
Resistance Force ◽  
Novel Technique ◽  
Long Head ◽  
Peak Resistance ◽  
Conjoint Tendon

Background: Augmentation of Bankart repair with long head of the biceps tendon transfer has been previously described, although there is a paucity of literature describing its biomechanical effects. Purpose/Hypothesis: The purpose of this study was to assess the effect of augmenting Bankart repair with either the conjoint tendon or the long head of the biceps tendon, both with and without subcritical (13%) glenoid bone loss. We hypothesized that, in a cadaveric model, augmenting Bankart repair with the long head of the biceps tendon would restore a greater degree of stability compared with augmenting Bankart repair with the conjoint tendon. Study Design: Controlled laboratory study. Methods: A total of 12 cadaveric shoulders were tested on a 6-degrees-of-freedom robotic musculoskeletal simulator to measure the peak resistance force due to an anterior displacement of 1 cm. The rotator cuff muscles were loaded during testing to simulate physiological conditions. The following test conditions were used for each specimen: (1) intact shoulder, (2) Bankart lesion with 13% anterior bone loss, (3) 13% bone loss with Bankart repair (anchors placed at the 3-, 4-, and 5-o’clock positions), (4) 13% bone loss with both Bankart repair and transfer of the long head of the biceps tendon, and (5) 13% bone loss with Bankart repair and transfer of the conjoint tendon. Results: Labral repair with the addition of long head of the biceps tendon transfer had the greatest peak resistance force to anterior displacement among all groups (54.1 ± 5.5 N) and was significantly stronger than both standard Bankart repair by 16.3% (46.5 ± 7.6 N; P = .039) and the conjoint transfer procedure by 16.6% (46.4 ± 7.7 N; P = .008). Conclusion: Given the susceptibility of recurrent instability in shoulders with subcritical bone loss after isolated labral repair, it is important to consider augmenting Bankart repair in high-risk patients to avoid potential recurrence and the need for reoperations. Transferring the long head of the biceps tendon to the anterior glenoid represents one possible augmentation. Clinical Relevance: We present biomechanical data for a relatively novel technique for augmenting capsulolabral repair strength in an anterior instability model with subcritical bone loss. These data represent biomechanical justification for the utilization of this relatively novel technique.

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.

scholarly journals Arthroscopic Repair of the Bankart Lesion Using Dual-Row Labral Repair

2021 ◽  
Vol 1 (4) ◽  
pp. 263502542110164
Author(s):  
Bryan Loh ◽  
Denny Tjiauw Tjoen Lie
Keyword(s):  
Suture Anchor ◽  
Glenohumeral Joint ◽  
Bankart Lesion ◽  
Labral Repair ◽  
Double Row ◽  
Inferior Aspect ◽  
Anterior Glenoid ◽  
Anterolateral Portal ◽  
Common Technique ◽  
The Right

Background: The most common technique described for bankart repair is the single-row labral repair. Recent interest has been the use of a dual-row, double pulley technique, first described by Zhang et al and popularized by Millett et al as the “bony Bankart bridge” technique. The aim of this study is to report a double-row all-suture labral fixation technique using knotless anchors. Technique: Step 1: glenohumeral debridement, and preparation of the glenoid labral and Bankart. The patient is first placed in the beach-chair position and surface landmarks are created. The standard posterior portal is first created and the glenohumeral joint is evaluated. Once the lesion is identified, the relevant working anterosuperior and anteroinferior portals are established using the outside-in technique. The synovitis is debrided to allow visualization and the labrum is liberated from the anterior glenoid. The Bankart lesion fragment is liberated, and partial fragments are osteotomized. With the anterolateral portal as the viewing portal, the anterior rim of the glenoid is now decorticated using a motorized shaver and rasp to create a bleeding bony surface. Step 2: the low rim anchor (5:30 o’clock). At the anterior-inferior aspect of the glenoid, the drill guide is positioned as low as possible (5:30 o’clock position for the right shoulder) and about 7 to 10 mm medial to the rim of the glenoid. The first 1.8 mm single-loaded suture anchor (Q-FIX All-Suture Anchor) is then inserted via the posterior portal. Step 3: the anterior-inferior-medial (AIM) anchor (4 o’clock). Step 4: the knotless high rim anchor (3 o’clock). Step 5: tying of sutures. The sutures from each anchor are tied in a mattress configuration, eventually creating a suture bridge over the labral repair Discussion/Conclusion: This dual row labral repair technique allows for maximum compression and contact between the fragment and the glenoid bed, allowing healing over a contact area rather than just the rim. The other added advantage is the use of curved tip anchors which allow negotiation of difficult corners, especially in the 5 to 6 o’clock position.

scholarly journals Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110018
Author(s):  
Emilio Calvo ◽  
Gonzalo Luengo ◽  
Diana Morcillo ◽  
Antonio M. Foruria ◽  
María Valencia
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Revision Surgery ◽  
Shoulder Instability ◽  
Activity Level ◽  
Bankart Repair ◽  
Anterior Shoulder Instability ◽  
Arthroscopic Bankart Repair ◽  
Functional Scores ◽  
Arthroscopic Latarjet

Background: Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization. Purpose/Hypothesis: To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures. Results: No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups. Conclusion: Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

Recurrence and Revision Rates With Arthroscopic Bankart Repair Compared With the Latarjet Procedure in Competitive Rugby Players With Glenohumeral Instability and a Glenoid Bone Loss <20%

2021 ◽  
Vol 49 (4) ◽  
pp. 866-872
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Maximiliano Ranalletta
Keyword(s):  
Bone Loss ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Glenoid Bone Loss ◽  
Bankart Repair ◽  
Latarjet Procedure ◽  
Glenohumeral Instability ◽  
Arthroscopic Bankart Repair ◽  
Significant Difference ◽  
Rugby Players

Background: There is a lack of evidence in the literature comparing outcomes between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Purpose: To compare return to sport, functional outcomes, and complications between the arthroscopic Bankart repair and the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20%. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2010 and February 2018, 130 competitive rugby players with anterior shoulder instability were operated on in our institution. The first 80 patients were operated on with the arthroscopic Bankart procedure and the other 50 with the open Latarjet procedure. Return to sport, range of motion (ROM), the Rowe score, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences, reoperations, and complications were also evaluated. Results: In the total population, the mean follow-up was 40 months (range, 24-90 months) and the mean age was 24.2 years (range, 16-33 years). Ninety-two percent of patients were able to return to rugby, 88% at their preinjury level of play. Eighty-nine percent of patients in the Bankart group and 87% in the Latarjet group returned to compete at the same level ( P = .788). No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe and ASOSS scores showed statistical improvement after operation ( P < .01). No significant difference in functional scores was found between the groups The Rowe score in the Bankart group increased from a preoperative mean (± SD) of 41 ± 13 points to 89.7 points postoperatively, and in the Latarjet group, from a preoperative mean of 42.5 ± 14 points to 88.4 points postoperatively ( P = .95). The ASOSS score in the Bankart group increased from a preoperative mean of 53.3 ± 3 points to 93.3 ± 6 points postoperatively, and in the Latarjet group, from a preoperative mean of 53.1 ± 3 points to 93.7 ± 4 points postoperatively ( P = .95). There were 18 recurrences (14%). The rate of recurrence was 20% in the Bankart group and 4% in the Latarjet group ( P = .01). There were 15 reoperations (12%). The rate of reoperation was 16% in the Bankart group and 4% in the Latarjet group ( P = .03). There were 6 complications (5%). The rate of complications was 4% in the Bankart group and 6% in the Latarjet group ( P = .55). The proportion of postoperative osteoarthritis was 10% in the Bankart group (8/80 patients) and 12% (6/50 patients) in the Latarjet group ( P = .55). Conclusion: In competitive rugby players with glenohumeral instability and a glenoid bone loss <20%, both the arthroscopic Bankart repair and the Latarjet procedure produced excellent functional outcomes, with most athletes returning to sport at the same level they had before the injury. However, the Bankart procedure was associated with a significantly higher rate of recurrence (20% vs 4%) and reoperation (16% vs 4%) than the Latarjet procedure.

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.

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