Normalization of Glenohumeral Articular Contact Pressures After Latarjet or Iliac Crest Bone-Grafting

BACKGROUND:Multiple bone-grafting procedures have been described for patients with glenoid bone loss and shoulder instability. The purpose of this study was to investigate the alterations in glenohumeral contact pressure associated with the placement and orientation of Latarjet or iliac crest bone g...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2010-06, Vol.92 (6), p.1478-1489
Main Authors: Ghodadra, Neil, Gupta, Aman, Romeo, Anthony A, Bach, Bernard R, Verma, Nikhil, Shewman, Elizabeth, Goldstein, Jordan, Provencher, Matthew T
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Bone Transplantation - methods
Cadaver
Diseases of the osteoarticular system
Humans
Ilium - transplantation
Medical sciences
Middle Aged
Orthopedic surgery
Pressure
Range of Motion, Articular
Scapula - transplantation
Shoulder Joint - physiopathology
Shoulder Joint - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Transplantation, Autologous
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Summary:BACKGROUND:Multiple bone-grafting procedures have been described for patients with glenoid bone loss and shoulder instability. The purpose of this study was to investigate the alterations in glenohumeral contact pressure associated with the placement and orientation of Latarjet or iliac crest bone graft augmentation and to compare the amount of glenoid bone reconstruction with two coracoid face orientations. METHODS:Twelve fresh-frozen cadaver shoulders were tested in static positions of humeral abduction (30°, 60°, and 60° with 90° of external rotation) with a 440-N compressive load. Glenohumeral contact pressure and area were determined sequentially for (1) the intact glenoid; (2) a glenoid with an anterior bone defect involving 15% or 30% of the glenoid surface area; (3) a 30% glenoid defect treated with a Latarjet or iliac crest bone graft placed 2 mm proud, placed flush, or recessed 2 mm in relation to the level of the glenoid; and (4) a Latarjet bone block placed flush and oriented with either the lateral (Latarjet-LAT) or the inferior (Latarjet-INF) surface of the coracoid as the glenoid face. The amount of glenoid bone reconstructed was compared between the Latarjet-LAT and Latarjet-INF conditions. RESULTS:Bone grafts in the flush position restored the mean peak contact pressure to 116% of normal when the iliac crest bone graft was used (p < 0.03 compared with the pressure with the 30% defect), 120% when the Latarjet-INF bone block was used (p < 0.03), and 137% when the Latarjet-LAT bone block was used (p < 0.04). Use of the Latarjet-LAT bone block resulted in mean peak pressures that were significantly higher than those associated with the iliac crest bone graft (p < 0.02) or the Latarjet-INF bone block (p < 0.03) at 60° of abduction and 90° of external rotation. With the bone grafts placed in a proud position, peak contact pressure increased to 250% of normal (p < 0.01) in the anteroinferior quadrant and there was a concomitant increase in the posterosuperior glenoid pressure to 200% of normal (p < 0.02), indicating a shift posteriorly. Peak contact pressures of bone grafts placed in a recessed position revealed high edge-loading. Augmentation with the Latarjet-LAT bone block led to restoration of the glenoid articular contact surface from the 30% defect state to a 5% defect state. Augmentation of the 30% glenoid defect with the Latarjet-INF bone block resulted in complete restoration to the intact glenoid articular surface area. CONCLUSIONS:Glen
ISSN:0021-9355
1535-1386
DOI:10.2106/JBJS.I.00220