Biomechanical Analysis of Posterior Open-Wedge Osteotomy and Glenoid Concavity Reconstruction Using an Implant-Free, J-Shaped Iliac Crest Bone Graft
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2022-12
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Journal Article
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Abstract
Background: Posterior open-wedge osteotomy and glenoid reconstruction using a J-shaped iliac crest bone graft showed promising clinical results for the treatment of posterior instability with excessive glenoid retroversion and posteroinferior glenoid deficiency. Purpose: To evaluate the biomechanical performance of the posterior J-shaped graft to restore glenoid retroversion and posteroinferior deficiency in a cadaveric shoulder instability model. Study Design: Controlled laboratory study. Methods: A posterior glenoid open-wedge osteotomy was performed in 6 fresh-frozen shoulders, allowing the glenoid retroversion to be set at 0 degrees, 10 degrees, and 20 degrees. At each of these 3 preset angles of glenoid retroversion, the following conditions were simulated: (1) intact joint, (2) posterior Bankart lesion, (3) 20% posteroinferior glenoid deficiency, and (4) posterior J-shaped graft (at 0 degrees of retroversion). With the humerus in the Jerk position (60 degrees of glenohumeral anteflexion, 60 degrees of internal rotation), stability was evaluated by measuring posterior humeral head (HH) translation (in mm) and peak translational force (in N) to translate the HH over 25% of the glenoid width. Glenohumeral contact patterns were measured using pressure-sensitive sensors. Fixation of the posterior J-graft was analyzed by recording graft micromovements during 3000 cycles of 5-mm anteroposterior HH translations. Results: Reconstructing the glenoid with a posterior J-graft to 0 degrees of retroversion significantly increased stability compared with a posterior Bankart lesion and posteroinferior glenoid deficiency in all 3 preset degrees of retroversion (P < .05). There was no significant difference in joint stability comparing the posterior J-graft with an intact joint at 0 degrees of retroversion. The posterior J-graft restored mean contact area and contact pressure comparable with that of the intact condition with 0 degrees of retroversion (222 vs 223 mm(2), P = .980; and 0.450 vs 0.550 MPa, P = .203). The mean total graft displacement after 3000 cycles of loading was 43 +/- 84 mu m, and the mean maximal mediolateral graft bending was 508 +/- 488 mu m. Conclusion: Biomechanical analysis of the posterior J-graft demonstrated reliable restoration of initial glenohumeral joint stability, normalization of contact patterns comparable with that of an intact shoulder joint with neutral retroversion, and secure initial graft fixation in the cadaveric model.
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50 (14)
Pages / Article No.
3889 - 3896
Publisher
SAGE
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Subject
shoulder instability; glenoid retroversion; glenoid dysplasia; open-wedge osteotomy; posterior J-graft; biomechanics
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03822 - Snedeker, Jess G. / Snedeker, Jess G.