The Biomechanical Effect of Bone Grafting and Bone Graft Remodeling in Patients With Anterior Shoulder Instability

Abstract

Background: Individual constitutional differences in glenoid shape and bone remodeling require a patient-specific and longitudinal approach to evaluate the biomechanical effects of glenoid bone grafting in patients with anterior shoulder instability. Purpose: To quantify the longitudinal, in vivo, biomechanical effects of bone grafting, bone graft remodeling, and glenoid shape in patients with anterior shoulder instability by means of patient-specific finite element models. Study Design: Descriptive laboratory study. Methods: In total, 25 shoulders of 24 patients with anterior shoulder instability and anterior glenoid bone loss underwent an arthroscopic iliac crest bone graft transfer (ICBGT) procedure with either autologous or allogenic bone. Patient-specific finite element simulations based on preoperative, postoperative, and follow-up computed tomography scans were used to quantify the bone-mediated stability ratio (SR) and the distance to dislocation. Additionally, the relationship between glenoid morphological parameters and the SR was assessed. Results: The ICBGT procedure significantly increased the SR and distance to dislocation in the 2-, 3-, and 4-o’clock directions immediately after the surgical intervention ( P < .01) in both the autograft and the allograft groups. Although the SR and distance to dislocation decreased subsequently, autografts showed long-term effects on SR and dislocation distance in the 3-o’clock direction ( P < .01) and on SR in the 4-o’clock direction ( P < .01). Allografts showed no significant effect on SR and dislocation distance in long-term follow-up ( P > .05). Overall, glenoid retroversion as well as cavity depth predicted stability in all 4 dislocation directions, with glenoid cavity depth showing the highest correlation coefficients ( R = 0.71, 0.8, 0.73, and 0.7 for 2-, 3-, 4-, and 5-o’clock, respectively). Conclusion: The autologous ICBGT procedure biomechanically improved anterior shoulder stability in long-term follow-up, whereas the use of allografts did not show any bone-mediated biomechanical effect at follow-up due to resorption. Furthermore, in addition to measurements of defect extent, the glenoid depth and version seem to be useful parameters to determine the biomechanical effect and need for glenoid bone grafting in patients with shoulder instability. Clinical Relevance: This study proposes the use of autologous bone grafts for a successful long-term stabilization effect. Additionally, this study proposes additional glenoid morphological measures to predict shoulder stability.

Lipoteichoic Acid Accelerates Bone Healing by Enhancing Osteoblast Differentiation and Inhibiting Osteoclast Activation in a Mouse Model of Femoral Defects

“…However, limited autografts are available and are accompanied with high risks during harvest for wound infection and postoperative pain [ 7 ]. Allogenic bone grafts provide a relatively safe alternative over autografts, which have donor-site disadvantages due to their processing in terms of sterilization and storage, which in turn causes losses of osteogenic and osteoinductive capabilities [ 8 ]. The molecular targets for local or systemic applications (parathyroid hormone, the Wnt-signaling pathway, sclerostin, bone morphogenic proteins, platelet-derived growth factor and fibroblast growth factor) have provided benefits for regulating bone regeneration [ 9 ].…”

Measurement of the Balance Stability Angle to Predict the Stability Ratio in Patients With Recurrent Anterior Shoulder Dislocation: A Novel Computed Tomography–Based Protocol

“…Regarding previous radiological studies on the SR estimation, Sigrist et al 18 explored the relationship between CT-based glenoid parameters (glenoid depth, width, and retroversion) and the SR calculated by FEA. The reported correlation coefficients were 0.7 to 0.8 between the glenoid depth and the SR from 2 o’clock to 5 o’clock.…”

“…Finite element analysis (FEA) can be conducted to calculate the SR for specific patients; nevertheless, it also requires technology and is time-consuming for surgeons. 9 , 15 , 16 , 18 , 21 , 26 In clinical practice, the load and shift test is usually performed to examine the SR of patients with RASD, but the result is qualitative and dependent on the experience of the examiner.…”

Immunomodulation of Telmisartan-Loaded PCL/PVP Scaffolds on Macrophages Promotes Endogenous Bone Regeneration

“…Bone defects caused by severe trauma, infection, tumor resection, or developmental deformity have remained a significant challenge for orthopedists and are both an economical and mental burden for patients. , Autologous bone grafts are considered the “gold standard” to treat bone defects and are the most commonly used treatment in clinics due to their more predictable postimplant outcomes, zero immunogenicity, and easy incorporation into the defective site. − However, autologous bone grafts are not available all the time, and associated complications, including poor bone union/nonunion, infection surrounding the implants, and invasive harvesting procedures, have restricted their application. ,, …”