The novel arthroscopic subscapular quadriceps tendon–bone sling procedure provides increased stability in shoulder cadavers with severe glenoid bone loss

Vagstad

et al. 2021

Arthroscopy Techniques

Self Cite

There are numerous arthroscopic techniques available to address anterior shoulder instability. Complications are various, and in pursuit of new treatment options, an alternative arthroscopic technique with less potential for complications has been developed. The novel subscapular sling with a semitendinosus graft provides both dynamic and static stability. This procedure uses a semitendinosus graft as a sling around the upper two-thirds of the subscapular tendon, attached to the anterior glenoid rim. The sling phenomenon present in the Latarjet procedure was the basis of the development. The efficacy of the subscapular sling procedure has been verified in biomechanical studies and further investigated in a clinical pilot study. The procedure can be performed without altering the anatomy of nearby structures such as the coracoid process, the conjoined tendon, and the axillary and musculocutaneous nerves. The authors propose the arthroscopic subscapular sling procedure as an alternative to existing surgical treatment options for recurrent anterior shoulder instability.

Section: Discussionmentioning

confidence: 99%

Dynamic and Static Stabilization of Anterior Shoulder Instability With the Subscapular Sling Procedure

Vagstad

et al. 2021

Arthroscopy Techniques

Self Cite

“…Their protocols varied slightly between studies, but they generally measured glenohumeral stability in the anterior, inferior and anteroinferior directions, as well as external rotation ROM. Recently, their protocol was used to evaluate a novel surgical technique to stabilize the shoulder, described by Klungsøyr et al [6] and Vagstad et al [9]. Similar biomechanical studies have been described for the spine [28], hip [22] and knee [29].…”

Section: A Related Workmentioning

confidence: 97%

“…Additionally, the technical publications we found on this topic seem to focus on individual cadaveric joint types. Lastly, institutions that facilitates such biomechanical studies, regardless of machine or actuator, seems to either develop their own closed mathematical models and software [6], [22], or use the proprietary and closed source software package called simVITRO® [30]. simVITRO® [31] was designed to perform in vitro cadaveric biomechanical studies, and serves both as a middleware and a higher level motion planner for biomechanical studies.…”

Section: A Related Workmentioning

confidence: 99%

“…Here, 0 ≤ s ≤ 1 is the interpolation parameter, S(•) calculates the contribution from each endpoint during interpolation as shown in (6), and θ is the geodesic angle between q a and q b . This angle can be reused from the axis-angle pair, or calculated as shown in (7) [35], where ⟨•⟩ denotes dot product.…”

Section: A Mathematical Notation and Backgroundmentioning

confidence: 99%

“…In these applications, the robots assist surgeons with their high durability, precision and accuracy. A related use in the field is robot-assisted surgical research, where robots perform biomechanical tests on human cadaveric specimens [6]. Here, the robots replicate in cadavers one or multiple anatomical motions to measure the joint Range of Motion (ROM), or the robot can apply a force and measure the resulting linear translation.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Quantifying Passive Biomechanical Stability Using an Industrial Robot: Development and Experimental Validation of a Task Space Motion Framework

Skrede,

Dalen,

Hellevik

et al. 2024

IEEE Access

This paper presents a methodology and generalized motion framework for quantifying passive biomechanical stability and Range of Motion of human cadaveric specimens, using a position-controlled industrial robot and a wrist-mounted force/torque sensor. Many biomechanical studies on diarthrodial joints using human cadaveric specimens are published in the literature, using various test protocols and machines to apply the loading conditions. In these studies, laxity or mobility of the joints are quantified by measuring the magnitude of translations and rotations with respect to force and torque. The protocols and anatomical motions of the specimens are usually described high-level, textually, and from a medical perspective to a broad audience. The present paper aims to describe, from a technical perspective to a robotics audience, our method to perform biomechanical studies and how existing protocols can be replicated through parameterization using the existing textual descriptions. To accomplish this, we propose a generalized task space motion framework for performing biomechanical studies on diarthrodial joints. The generalization is made by defining the robot Tool Center Point at the cadaveric joint rotation center and aligning the specimen so the anatomical motions can be modeled in world frame or tool frame. The framework was successfully evaluated in a technical pilot study on the shoulder, using one cadaveric shoulder specimen and an established protocol from the literature. The specimen was tested in the intact state and in an injury state, with increased passive instability observed for the injury state compared to intact state.

Biomechanical comparison shows increased stability of an arthroscopic subscapular sling procedure compared to an open Latarjet reconstruction for anterior shoulder instability in specimens with major glenoid bone defect

Vagstad,

Klungsøyr,

Bjerknes

et al. 2024

J. exp. orthop.

PurposeRecurrent anterior glenohumeral instability (RASI) is commonly treated with arthroscopic techniques, though their effectiveness in providing stability may diminish in cases of critical glenoid bone loss. This study aimed to compare the stability outcomes and range of motion (ROM) associated with an arthroscopic subscapular sling procedure (SSP), first introduced in 2015.MethodsSixteen fresh‐frozen human cadaveric shoulder specimens were biomechanically evaluated in four conditions: native, injured, post‐SSP and post‐LP. Glenohumeral translations were measured under anterior, anteroinferior and inferior loading, while external rotation ROM was assessed in neutral and abducted positions. Testing was conducted using a robotic system for precise force and torque application. Specimens were prepared with a 20% glenoid bone defect and subjected to stability testing sequentially.ResultsThe SSP significantly reduced glenohumeral translations compared to LP, particularly under anterior loading in neutral (p < 0.001), external rotation (p = 0.007) and abduction (p < 0.001) positions. Although the SSP demonstrated superior stability in these key positions, it did not consistently outperform the LP across all scenarios, as stability was similar between the two in the abducted and rotated position under anterior loading (p = 0.379). Under anteroinferior loading, the SSP showed comparatively better stability at neutral (p = 0.003) and abduction (p < 0.001), whereas the LP led to greater anteroinferior translations in these same positions (p = 0.002 and p = 0.014, respectively). The SSP outperformed the LP under inferior loading in neutral (p = 0.005) and abduction (p = 0.02) positions, though it did not fully restore stability to native shoulder levels. The SSP maintained ROM similar to native shoulders. LP allowed greater ROM, potentially compromising stability.ConclusionThe SSP provided greater stability than the open Latarjet in most positions and did not limit ROM, suggesting it could be a viable, less invasive option for managing shoulder instability.Level of EvidenceNot applicable.