The critical size of a defect in the glenoid causing anterior instability of the shoulder after a Bankart repair, under physiological joint loading
File(s)Manuscript_R1.pdf (282.85 KB)
Accepted version
Author(s)
Type
Journal Article
Abstract
AIMS: Patients with recurrent anterior dislocation of the shoulder commonly have an anterior osseous defect of the glenoid. Once the defect reaches a critical size, stability may be restored by bone grafting. The critical size of this defect under non-physiological loading conditions has previously been identified as 20% of the length of the glenoid. As the stability of the shoulder is load-dependent, with higher joint forces leading to a loss of stability, the aim of this study was to determine the critical size of an osseous defect that leads to further anterior instability of the shoulder under physiological loading despite a Bankart repair. PATIENTS AND METHODS: Two finite element (FE) models were used to determine the risk of dislocation of the shoulder during 30 activities of daily living (ADLs) for the intact glenoid and after creating anterior osseous defects of increasing magnitudes. A Bankart repair was simulated for each size of defect, and the shoulder was tested under loading conditions that replicate in vivo forces during these ADLs. The critical size of a defect was defined as the smallest osseous defect that leads to dislocation. RESULTS: The FE models showed a high risk of dislocation during ADLs after a Bankart repair for anterior defects corresponding to 16% of the length of the glenoid. CONCLUSION: This computational study suggests that bone grafting should be undertaken for an anterior osseous defect in the glenoid of more than 16% of its length rather than a solely soft-tissue procedure, in order to optimize stability by restoring the concavity of the glenoid.
Date Issued
2019-01
Date Acceptance
2018-11-08
Citation
Bone and Joint Journal, 2019, 101-B (1), pp.68-74
ISSN
2049-4394
Publisher
British Editorial Society of Bone and Joint Surgery
Start Page
68
End Page
74
Journal / Book Title
Bone and Joint Journal
Volume
101-B
Issue
1
Copyright Statement
©2019 The British Editorial Society of Bone & Joint Surgery
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30601049
Subjects
Bankart repair
Bone grafting
Finite element analysis
Glenoid bone loss
Shoulder stability
Activities of Daily Living
Arthroscopy
Bone Transplantation
Computer Simulation
Female
Glenoid Cavity
Humans
Joint Instability
Male
Range of Motion, Articular
Recurrence
Shoulder Dislocation
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2019-01-02