Correction of Static Posterior Shoulder Subluxation by Restoring Normal Scapular Anatomy Using Acromion and Glenoid Osteotomies

Gerber, Christian; Sigrist, Bastian; Hochreiter, Bettina

doi:10.2106/jbjs.cc.23.00060

Cited by 8 publications

(2 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study results could explain the high failure rates of conventional operative treatment for posterior instability and incipient eccentric OA [4, 7, 16]. They would suggest combined (glenoid and acromion) osteotomies planned on quantitative 3‐D analyses of individual B1 scapulae and planned restoration of the anatomy as near as possible to the normal shoulder [8].…”

Section: Discussionmentioning

confidence: 98%

Posterior stability of the shoulder depends on acromial anatomy: a biomechanical study of 3D surface models

et al. 2023

Self Cite

View full text Add to dashboard Cite

Purpose Primary glenohumeral osteoarthritis is commonly associated with static posterior subluxation of the humeral head. Scapulae with static/dynamic posterior instability feature a superiorly and horizontally oriented acromion. We investigated whether the acromion acts as a restraint to posterior humeral translation. Methods Five three-dimensional (3D) printed scapula models were biomechanically tested. A statistical shape mean model (SSMM) of the normal scapula of 40 asymptomatic shoulders was fabricated. Next, a SSMM of scapular anatomy associated with posterior subluxation was generated using data of 20 scapulae (“B1”). This model was then used to generate three models of surgical correction: glenoid version, acromial orientation, and acromial and glenoid orientation. With the joint axially loaded (100N) and the humerus stabilized, an anterior translation force was applied to the scapula in 35°, 60° and 75° of glenohumeral flexion. Translation (mm) was measured. Results In the normal scapula, the humerus translates significantly less to contact with the acromion compared to all other configurations (p < .000 for all comparisons; i.e. 35°: “normal” 8,1 mm (± 0,0) versus “B1” 11,9 mm (± 0,0) versus “B1 Acromion Correction” 12,2 mm (± 0,2) versus “B1 Glenoid Correction” 13,3 mm (± 0,1)). Restoration of normal translation was only achieved with correction of glenoid and acromial anatomy (i.e. 75°: “normal” 11 mm (± 0,8) versus “B1 Acromion Correction” 17,5 mm (± 0,1) versus “B1 Glenoid Correction” 19,7 mm (± 1,3) versus “B1 Glenoid + Acromion Correction” 11,5 mm (± 1,1)). Conclusions Persistence or recurrence of static/dynamic posterior instability after correction of glenoid version alone may be related to incomplete restoration of the intrinsic stability that is conferred by a normal acromial anatomy. Level of Evidence V biomechanical study

show abstract

Section: Discussionmentioning

confidence: 98%

Posterior stability of the shoulder depends on acromial anatomy: a biomechanical study of 3D surface models

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Nonetheless, our experimental setup provides insight into possible biomechanical causes of joint degeneration in shoulder muscle pathology. Furthermore, our simulator may be used to investigate the biomechanical implications of novel surgical approaches such as those involving morphological changes, as shown in a recent case study by Gerber et al [ 39 ], who demonstrated that osteotomy involving morphological modifications of the acromion and glenoid to correct abnormal morphological parameters can lead to improved patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Influence of Critical Shoulder Angle and Rotator Cuff Tear Type on Load‐Induced Glenohumeral Biomechanics: A Sawbone Simulator Study

Genter,

Croci,

Müller

et al. 2024

Applied Bionics and Biomechanics

View full text Add to dashboard Cite

Glenohumeral (GH) biomechanics after rotator cuff (RC) tears are not fully understood. The purpose of our study was to determine if the critical shoulder angle (CSA), type of RC tears, and level of weight bearing increase GH translation, instability based on the instability ratio, muscle forces and joint reaction force (JRF), and shifts the center of force (CoF) superiorly. A GH simulator with muscle‐mimicking cable systems was used to simulate 30° abduction in the scapular plane. A Sawbone humerus and five specimen‐specific scapular anthropometries were used to test six types of RC tears, three weight‐bearing loads, and the native and adjusted (to different CSAs) deltoid origin sites. Linear mixed effects models (CSA, RC tear type, and weight bearing) with random effects (specimen and sex) were used to assess differences in GH biomechanics. With increasing CSA, GH translation increased, JRF decreased, and the CoF position was more inferior. RC tears did not significantly alter GH translation but shifted the CoF position superiorly, close to where glenoid erosion occurs in patients with RC tears with secondary osteoarthritis. Weight bearing significantly increased GH translation and JRF. RC and deltoid muscle forces increased with the presence of RC tears and increased weight bearing. The remaining RC muscles of intact tendons compensated for the torn RC tendons but not for the altered CoF position. GH translation remained comparable to shoulders with intact RC. These findings highlight the importance of early detection, clinical management, and targeted rehabilitation strategies for patients with RC tears.

show abstract

Good functional outcome but high rates of instability recurrence after posterior open‐wedge glenoid osteotomy for the treatment of posterior shoulder instability with increased glenoid retroversion at mid‐term follow‐up

Hinz,

Fritsch,

Siebenlist

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeTo evaluate clinical, functional and radiological mid‐term outcomes following posterior open‐wedge glenoid osteotomy (POWGO) for the treatment of posterior shoulder instability (PSI) associated with increased glenoid retroversion.MethodsPatients who underwent POWGO for the treatment of symptomatic PSI with glenoid retroversion >10° and participated in a previous study assessing short‐term outcomes were included after a minimum follow‐up of 5 years. Clinical (Rowe score and physical examination) and functional outcomes (Oxford Shoulder Instability Score [OSIS] and visual analogue scale [VAS] for pain) were assessed. Preoperative versus follow‐up magnetic resonance imaging (MRI) assessments were compared for changes in posterior humeral head subluxation (PHHS) and progression of osteoarthritis (shoulder osteoarthritis severity [SOAS] score).ResultsEight patients (nine shoulders) were included 92.0 months (88.0–109.5 months) post‐operatively, of which seven patients (eight shoulders) underwent MRI. Shoulder function was good (Rowe score: 80.0 [76.3–91.3], OSIS: 41.0 [31.0–41.5]) and pain levels were low (VAS for pain: 3.0 [1.0–3.0]) at follow‐up. Overall, the degree of PHHS did not change between preoperatively and follow‐up (p > 0.05). Four shoulders demonstrated PHHS preoperatively, of which two had a centred humeral head at follow‐up. Shoulder osteoarthritis progressed significantly (SOAS score: 17.0 [11.0–24.5] to 33.0 [31.0–45.0], p = 0.018). Residual PSI was evident in 75.0% of shoulders.ConclusionAt mid‐term follow‐up, POWGO for PSI associated with increased glenoid retroversion led to good functional outcomes but failed to reliably restore posterior shoulder stability and prevent osteoarthritis progression.Level of EvidenceLevel IV.

show abstract

Correction of Static Posterior Shoulder Subluxation by Restoring Normal Scapular Anatomy Using Acromion and Glenoid Osteotomies

Cited by 8 publications

References 23 publications

Posterior stability of the shoulder depends on acromial anatomy: a biomechanical study of 3D surface models

Posterior stability of the shoulder depends on acromial anatomy: a biomechanical study of 3D surface models

Influence of Critical Shoulder Angle and Rotator Cuff Tear Type on Load‐Induced Glenohumeral Biomechanics: A Sawbone Simulator Study

Good functional outcome but high rates of instability recurrence after posterior open‐wedge glenoid osteotomy for the treatment of posterior shoulder instability with increased glenoid retroversion at mid‐term follow‐up

Contact Info

Product

Resources

About