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Comparison of Glenohumeral Contact Pressures and Contact Area After Glenoid Reconstruction with Latarjet or Distal Tibial Osteochondral Allograft

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Comparison of Glenohumeral Contact Pressures and Contact Area After Glenoid Reconstruction with Latarjet or Distal Tibial Osteochondral Allograft

Nikhil N. Verma, MD, UNITED STATES Sanjeev Bhatia, MD, UNITED STATES Geoffrey S. Van Thiel, MD, MBA, UNITED STATES Deepti Gupta, BS, UNITED STATES Neil Ghodadra, MD, UNITED STATES Bernard R. Bach, Jr., MD, UNITED STATES Elizabeth Shewman, MS, UNITED STATES Vincent M. Wang, PhD, UNITED STATES Brian J. Cole, MD, MBA, UNITED STATES Anthony A. Romeo, MD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES

Rush University Medical Center, Chicago, IL, USA

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Anatomic Location

Shoulder Glenohumeral

Diagnosis / Condition

Instability

Sports Medicine

Basic Science Biomechanics

Treatment / Technique

Repair / Reconstruction

Summary: Reconstruction of anterior glenoid bone defects with distal tibial allograft may allow for improved joint congruity and lower peak forces within the glenohumeral joint than Latarjet reconstruction at 60 degrees abduction and the ABER position.

Introduction

Glenoid reconstruction with distal tibial allograft offers the theoretical advantage over Latarjet reconstruction of improved joint congruity and a cartilaginous articulation for the humeral head. The purpose of this study was to investigate changes in the magnitude and location of glenohumeral contact area, contact pressure, and peak forces after (1) creation of 30% anterior glenoid defect, subsequent glenoid bone augmentation with (2) a flush Latarjet coracoid graft or (3) a distal tibia osteochondral allograft. It was hypothesized that thedistal tibial bone graft would best normalize glenohumeral contact area, contact pressures and peak forces.

Methods

Eight cadaveric shoulder specimens were dissected free of all soft tissues and randomly tested in 3 static positions of humeral abduction--30°, 60°, and 60° abduction with 90° of external rotation (ABER)--with a 440-N compressive load. Glenohumeral contact area, contact pressure, and peak forces were determined sequentially using a digital pressure mapping system (Tekscan, South Boston, MA) for (1) the intact glenoid; (2) the glenoid with a 30% anterior bone defect; followed by (3) the glenoid after reconstruction with a distal tibial allograft or a Latarjet bone block.

Results

Glenoid reconstruction with distal tibial allografts resulted in significantly higher glenohumeral contact area than reconstruction with Latarjet bone blocks in 60° abduction and the ABER position (p<0.05). Distal tibial allograft reconstruction also demonstrated significantly lower peak forces than Latarjet reconstruction in the ABER position (p<0.05). In regards to the bone loss model, distal tibial allograft reconstruction exhibited significantly higher contact areas and significantly lower contact pressures and peak forces than the 30% defect model at all abduction positions. Latarjet reconstruction also followed this same pattern but differences in contact area and peak forces between the defect model and Latarjet reconstruction in the ABER position were not statistically significant (p>0.05).

Discussion

and Conclusions:
Reconstruction of anterior glenoid bone defects with distal tibial allograft may allow for improved joint congruity and lower peak forces within the glenohumeral joint than Latarjet reconstruction at 60 degrees abduction and the ABER position. Although these mechanical properties may translate into clinical differences, further studies are needed to understand their effects.