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 vs 7.0 N/m
and 10.0 N/m vs 5.0 N/m, P = .0002) and for on-track lesions at end-range rotation (10.1 N/m vs 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 vs 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.
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Article Info
Publication History
Published online: July 15, 2016
Accepted:
April 26,
2016
Received:
June 22,
2015
Footnotes
The authors report the following potential conflict of interest or source of funding: R.U.H. receives support from Arthrex. P.J.D. receives support from Arthrex. S.S.B. receives support from Arthrex. Study funding provided by Arthrex.
Identification
Copyright
© 2016 Published by Elsevier on behalf of the Arthroscopy Association of North America
