Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning

Laurent B. Willemot, Sarah F. Eby, Andrew R. Thoreson, Phillipe Debeer, Jan Victor, Kai Nan An, Olivier Verborgt

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. Methods: Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. Results: Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5N vs 27.3 ± 6.9N) and anteroinferior translation (22.0 ± 5.3N vs 29.3 ± 6.9N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. Conclusions: This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.

Original languageEnglish (US)
Pages (from-to)533-540
Number of pages8
JournalJournal of Shoulder and Elbow Surgery
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Bone Transplantation
Transplants
Bone and Bones
Humeral Head
Bursitis
Neck
Transplantation
Recurrence
Equipment and Supplies

Keywords

  • Basic science
  • Biomechanics
  • Biomechanics
  • Bone graft
  • Dislocation
  • Glenoid
  • Shoulder
  • Stability

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Willemot, L. B., Eby, S. F., Thoreson, A. R., Debeer, P., Victor, J., An, K. N., & Verborgt, O. (2015). Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning. Journal of Shoulder and Elbow Surgery, 24(4), 533-540. https://doi.org/10.1016/j.jse.2014.09.018

Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning. / Willemot, Laurent B.; Eby, Sarah F.; Thoreson, Andrew R.; Debeer, Phillipe; Victor, Jan; An, Kai Nan; Verborgt, Olivier.

In: Journal of Shoulder and Elbow Surgery, Vol. 24, No. 4, 01.04.2015, p. 533-540.

Research output: Contribution to journalArticle

Willemot, LB, Eby, SF, Thoreson, AR, Debeer, P, Victor, J, An, KN & Verborgt, O 2015, 'Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning', Journal of Shoulder and Elbow Surgery, vol. 24, no. 4, pp. 533-540. https://doi.org/10.1016/j.jse.2014.09.018
Willemot, Laurent B. ; Eby, Sarah F. ; Thoreson, Andrew R. ; Debeer, Phillipe ; Victor, Jan ; An, Kai Nan ; Verborgt, Olivier. / Iliac bone grafting of the intact glenoid improves shoulder stability with optimal graft positioning. In: Journal of Shoulder and Elbow Surgery. 2015 ; Vol. 24, No. 4. pp. 533-540.
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abstract = "Background: Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. Methods: Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50{\%}, 75{\%}, and 100{\%} below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. Results: Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5N vs 27.3 ± 6.9N) and anteroinferior translation (22.0 ± 5.3N vs 29.3 ± 6.9N). PF was significantly higher for the grafts at the 50{\%} and 75{\%} positions compared with the grafts 100{\%} below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100{\%} and 75{\%} positions compared with the 50{\%} position. Conclusions: This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.",
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AU - Victor, Jan

AU - An, Kai Nan

AU - Verborgt, Olivier

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AB - Background: Bone grafting procedures are increasingly popular for the treatment of anterior shoulder instability. In patients with a high risk of recurrence, open coracoid transplantation is preferred but can be technically demanding. Free bone graft glenoid augmentation may be an alternative strategy for high-risk patients without significant glenoid bone loss. This biomechanical cadaveric study assessed the stabilizing effect of free iliac crest bone grafting of the intact glenoid and the importance of sagittal graft position. Methods: Eight fresh frozen cadaveric shoulders were tested. The bone graft was fixed on the glenoid neck at 3 sagittal positions (50%, 75%, and 100% below the glenoid equator). Displacement and reaction force were monitored with a custom device while translating the humeral head over the glenoid surface in both anterior and anteroinferior direction. Results: Peak force (PF) increased significantly from the standard labral repair to the grafted conditions in both anterior (14.7 ± 5.5N vs 27.3 ± 6.9N) and anteroinferior translation (22.0 ± 5.3N vs 29.3 ± 6.9N). PF was significantly higher for the grafts at the 50% and 75% positions compared with the grafts 100% below the equator with anterior translation. Anteroinferior translation resulted in significantly higher values for the 100% and 75% positions compared with the 50% position. Conclusions: This biomechanical study confirms improved anterior glenohumeral stability after iliac crest bone graft augmentation of the anterior glenoid. The results also demonstrate the importance of bone graft position in the sagittal plane, with the ideal position determined by the direction of dislocation.

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