Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model
Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom...
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| Veröffentlicht in: | Arthroscopy 2016-12, Vol.32 (12), p.2466-2476 |
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| creator | Hartzler, Robert U., M.D., M.S Bui, Christopher N.H., M.D Jeong, Woong K., M.D Akeda, Masaki, M.D Peterson, Alex, B.A McGarry, Michelle, M.S Denard, Patrick J., M.D Burkhart, Stephen S., M.D Lee, Thay Q., Ph.D |
| description | Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m v 7.0 N/m and 10.0 N/m v 5.0 N/m, P = .0002) and for on-track lesions at end-range rotation (10.1 N/m v 5.0 N/m, P = .0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m v 7.0 N/m, P > .99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability. |
| doi_str_mv | 10.1016/j.arthro.2016.04.030 |
| format | Article |
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Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m v 7.0 N/m and 10.0 N/m v 5.0 N/m, P = .0002) and for on-track lesions at end-range rotation (10.1 N/m v 5.0 N/m, P = .0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m v 7.0 N/m, P > .99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.</description><identifier>ISSN: 0749-8063</identifier><identifier>EISSN: 1526-3231</identifier><identifier>DOI: 10.1016/j.arthro.2016.04.030</identifier><identifier>PMID: 27432588</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arthroscopy - methods ; Bankart Lesions - physiopathology ; Bankart Lesions - surgery ; Biomechanical Phenomena - physiology ; Cadaver ; Female ; Humans ; Joint Instability - physiopathology ; Joint Instability - surgery ; Male ; Middle Aged ; Orthopedics ; Osteolysis - physiopathology ; Shoulder Joint - physiopathology ; Suture Anchors</subject><ispartof>Arthroscopy, 2016-12, Vol.32 (12), p.2466-2476</ispartof><rights>2016</rights><rights>Copyright © 2016. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-7568d8b33648b199d29e596c8aa886cf857c2b91218118c9522caa89ba768e303</citedby><cites>FETCH-LOGICAL-c463t-7568d8b33648b199d29e596c8aa886cf857c2b91218118c9522caa89ba768e303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arthro.2016.04.030$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27432588$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hartzler, Robert U., M.D., M.S</creatorcontrib><creatorcontrib>Bui, Christopher N.H., M.D</creatorcontrib><creatorcontrib>Jeong, Woong K., M.D</creatorcontrib><creatorcontrib>Akeda, Masaki, M.D</creatorcontrib><creatorcontrib>Peterson, Alex, B.A</creatorcontrib><creatorcontrib>McGarry, Michelle, M.S</creatorcontrib><creatorcontrib>Denard, Patrick J., M.D</creatorcontrib><creatorcontrib>Burkhart, Stephen S., M.D</creatorcontrib><creatorcontrib>Lee, Thay Q., Ph.D</creatorcontrib><title>Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model</title><title>Arthroscopy</title><addtitle>Arthroscopy</addtitle><description>Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m v 7.0 N/m and 10.0 N/m v 5.0 N/m, P = .0002) and for on-track lesions at end-range rotation (10.1 N/m v 5.0 N/m, P = .0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m v 7.0 N/m, P > .99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.</description><subject>Arthroscopy - methods</subject><subject>Bankart Lesions - physiopathology</subject><subject>Bankart Lesions - surgery</subject><subject>Biomechanical Phenomena - physiology</subject><subject>Cadaver</subject><subject>Female</subject><subject>Humans</subject><subject>Joint Instability - physiopathology</subject><subject>Joint Instability - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Osteolysis - physiopathology</subject><subject>Shoulder Joint - physiopathology</subject><subject>Suture Anchors</subject><issn>0749-8063</issn><issn>1526-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks1u1DAUhS0EotPCGyDkJZsE_ySOs0GiFbRFA5U6sLYc54bx1LGndoI0D8E71-kUFmxYWVf-fK_PORehN5SUlFDxflfqOG1jKFmuSlKVhJNnaEVrJgrOOH2OVqSp2kISwU_QaUo7Qgjnkr9EJ6ypOKulXKHftzDunU1J_wQcBqw9vhmGYora3OEr61yx0Wab8BqSDR5fJ_wNDGQ8HvAU8C2kKUTA5zaMYLbaW6MdvnTgw3YeIebiS7B-wptJd9bZ6YCtxzrz--B0xOfBA16HlPDX0IN7hV4M2iV4_XSeoR-fP32_uCrWN5fXFx_XhakEn4qmFrKXHeeikh1t2561ULfCSK2lFGaQdWNY11JGJaXStDVjJl-1nW6EBE74GXp37LuP4X7OGtRokwHntIcwJ0UlEw2TDVvQ6oiamL8ZYVD7aMcsX1GiliDUTh2DUEsQilSKPE54-zRh7kbo_z7643wGPhwByDp_WYgqGQveQG8jmEn1wf5vwr8NjLOP_t_BAdIuzNFnDxVViSmiNssyLLtABSeMy5Y_ACJasIg</recordid><startdate>20161201</startdate><enddate>20161201</enddate><creator>Hartzler, Robert U., M.D., M.S</creator><creator>Bui, Christopher N.H., M.D</creator><creator>Jeong, Woong K., M.D</creator><creator>Akeda, Masaki, M.D</creator><creator>Peterson, Alex, B.A</creator><creator>McGarry, Michelle, M.S</creator><creator>Denard, Patrick J., M.D</creator><creator>Burkhart, Stephen S., M.D</creator><creator>Lee, Thay Q., Ph.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20161201</creationdate><title>Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model</title><author>Hartzler, Robert U., M.D., M.S ; Bui, Christopher N.H., M.D ; Jeong, Woong K., M.D ; Akeda, Masaki, M.D ; Peterson, Alex, B.A ; McGarry, Michelle, M.S ; Denard, Patrick J., M.D ; Burkhart, Stephen S., M.D ; Lee, Thay Q., Ph.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-7568d8b33648b199d29e596c8aa886cf857c2b91218118c9522caa89ba768e303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Arthroscopy - methods</topic><topic>Bankart Lesions - physiopathology</topic><topic>Bankart Lesions - surgery</topic><topic>Biomechanical Phenomena - physiology</topic><topic>Cadaver</topic><topic>Female</topic><topic>Humans</topic><topic>Joint Instability - physiopathology</topic><topic>Joint Instability - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Osteolysis - physiopathology</topic><topic>Shoulder Joint - physiopathology</topic><topic>Suture Anchors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hartzler, Robert U., M.D., M.S</creatorcontrib><creatorcontrib>Bui, Christopher N.H., M.D</creatorcontrib><creatorcontrib>Jeong, Woong K., M.D</creatorcontrib><creatorcontrib>Akeda, Masaki, M.D</creatorcontrib><creatorcontrib>Peterson, Alex, B.A</creatorcontrib><creatorcontrib>McGarry, Michelle, M.S</creatorcontrib><creatorcontrib>Denard, Patrick J., M.D</creatorcontrib><creatorcontrib>Burkhart, Stephen S., M.D</creatorcontrib><creatorcontrib>Lee, Thay Q., Ph.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Arthroscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hartzler, Robert U., M.D., M.S</au><au>Bui, Christopher N.H., M.D</au><au>Jeong, Woong K., M.D</au><au>Akeda, Masaki, M.D</au><au>Peterson, Alex, B.A</au><au>McGarry, Michelle, M.S</au><au>Denard, Patrick J., M.D</au><au>Burkhart, Stephen S., M.D</au><au>Lee, Thay Q., Ph.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model</atitle><jtitle>Arthroscopy</jtitle><addtitle>Arthroscopy</addtitle><date>2016-12-01</date><risdate>2016</risdate><volume>32</volume><issue>12</issue><spage>2466</spage><epage>2476</epage><pages>2466-2476</pages><issn>0749-8063</issn><eissn>1526-3231</eissn><abstract>Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m v 7.0 N/m and 10.0 N/m v 5.0 N/m, P = .0002) and for on-track lesions at end-range rotation (10.1 N/m v 5.0 N/m, P = .0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m v 7.0 N/m, P > .99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27432588</pmid><doi>10.1016/j.arthro.2016.04.030</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Arthroscopy - methods Bankart Lesions - physiopathology Bankart Lesions - surgery Biomechanical Phenomena - physiology Cadaver Female Humans Joint Instability - physiopathology Joint Instability - surgery Male Middle Aged Orthopedics Osteolysis - physiopathology Shoulder Joint - physiopathology Suture Anchors |
| title | Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model |
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