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Bankart Repair With Transferred Long Head of the Biceps Provides Better Biomechanical Effect Than Conjoined Tendon Transfer in Anterior Shoulder Instability With 20% Glenoid Defect

  • Yuhao Kang
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Liren Wang
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Mingqi Wang
    Affiliations
    Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    School of Basic Medical Science, Fudan University, Shanghai, China
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  • Yiyao Wei
    Affiliations
    Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    School of Basic Medical Science, Fudan University, Shanghai, China
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  • Yufeng Li
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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  • Jia Jiang
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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  • Suiran Yu
    Affiliations
    School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
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  • Jinzhong Zhao
    Correspondence
    Address correspondence to Guoming Xie, Ph.D.; and Jinzhong Zhao, Ph.D., Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth, People's Hospital, 600 Yishan Rd., Shanghai, China.
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Group, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    Search for articles by this author
  • Guoming Xie
    Correspondence
    Address correspondence to Guoming Xie, Ph.D.; and Jinzhong Zhao, Ph.D., Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth, People's Hospital, 600 Yishan Rd., Shanghai, China.
    Affiliations
    Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
    Search for articles by this author

      Purpose

      To examine the biomechanical differences between labral repair with transferred conjoined tendon and transferred long head of the biceps tendon (LHBT) for anterior shoulder instability with 20% bone loss.

      Methods

      Twelve cadaveric shoulders were tested in sequent 5 conditions: intact, 20% glenoid defect, Bankart repair, Bankart repair with transferred conjoined tendon (dynamic conjoined tendon sling, DCS), and with transferred LHBT (dynamic LHBT sling, DLS) at 60° of glenohumeral abduction and 60° of external rotation. The physiological glenohumeral joint load was created by forces applied to the rotator cuff, conjoined tendon, and LHBT. The glenohumeral compression force and range of motion were recorded before anteroinferior force application. The anterior, inferior, and total translations were measured with 20, 30, 40, and 50 N of anteroinferior force, respectively.

      Results

      Anteroinferior glenoid defect led to significant increase of humerus translation and decrease of glenohumeral compression force. DLS provided better resistance effect in both anterior–posterior and superior–inferior directions than DCS under high loading condition (40 N, P =.03; 50 N, P <.01). Both DCS and DLS procedures could further restore glenohumeral compression force with Bankart repair (Bankart repair: 32.1 ± 4.0 N; DCS: 36.7 ± 3.2 N, P < .01; DLS: 35.8 ± 3.6 N, P =.03). No range of motion restrictions were observed relative to the normal shoulder.

      Conclusions

      Both the DLS and DCS techniques could reduce the anterior–inferior translation and partially restore the glenohumeral stability in anterior shoulder instability with 20% anteroinferior glenoid defect compared with Bankart repair. Under greater loading conditions, DLS provides better stability than DCS.

      Clinical Relevance

      Shoulder stability can be restored by DLS and DCS with low load. With greater shoulder stability requirements, DLS might be a better option than DCS for anterior shoulder instability with 20% bone loss.
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