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. 2022 Mar 15;10(3):23259671221083579.
doi: 10.1177/23259671221083579. eCollection 2022 Mar.

Posterior Glenoid Osteotomy With Capsulolabral Repair Improves Resistance Forces in a Critical Glenoid Bone Loss Model

Stephen E Marcaccio  1 , Ryan M O'Donnel  1 , Rachel Schilkowsky  1 , Meng Brett D Owens  1 , Steven L Bokshan  1
Affiliations

Posterior Glenoid Osteotomy With Capsulolabral Repair Improves Resistance Forces in a Critical Glenoid Bone Loss Model

Stephen E Marcaccio et al. Orthop J Sports Med. .

Abstract

Background: There is no widespread consensus on the surgical treatment of posterior shoulder instability with critical posterior glenoid bone loss.

Hypothesis: That opening posterior glenoid wedge osteotomy with soft tissue repair would improve the resistance forces of instability when compared with soft tissue repair alone in the setting of 20% critical bone lose.

Study design: Controlled laboratory study.

Methods: Native glenoid retroversion was measured on 9 shoulders using computed tomography (CT) scans. The humerus was potted in 90° of forward flexion and 30° of internal rotation relative to the scapula, and a posterior dislocation was performed to create a posterior capsulolabral injury model. The specimens were each taken through a fixed sequence of testing: (1) posteroinferior capsulolabral tear, (2) no glenoid bone loss with posteroinferior capsulolabral repair, (3) 20% posterior glenoid bone loss with posteroinferior capsulolabral repair, and (4) 20% glenoid bone loss with posterior glenoid opening wedge osteotomy and posteroinferior capsulolabral repair. Bone loss was created using a sagittal saw. The resultant peak forces with 1 cm of posterior translation were measured. A 1-way repeated-measures analysis of variance was used to compare mean force values.

Results: After the initial dislocation event, all shoulders had a resultant posterior capsulolabral injury. The resulting labral injury was extended from 6- to 9-o'clock in all specimens to homogenize the extent of injury. Repairing the capsulolabral complex in the 20% posterior glenoid bone loss group did not result in a statistically significant increase in resistance force compared with the labral deficient group (34.1 vs 22.2 N; P = .068). When 20% posterior bone loss was created, the posterior glenoid osteotomy with capsulolabral repair was significantly stronger (43.8 N) than the posterior repair alone both with (34.1 N) and without (31.8 N) bone loss (P = .008 and .045, respectively).

Conclusion: In the setting of critical posterior glenoid bone loss, an opening wedge posterior glenoid osteotomy with capsulolabral repair improved resistance to posterior humeral translation significantly compared with capsulolabral repair alone.

Clinical relevance: The results of this biomechanical cadaveric study may aid in surgical planning for this complex patient population.

Keywords: dislocation; glenoid; instability; osteotomy; posterior.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: B.D.O. has received consulting fees from DePuy/Medical Device Business Services, Linvatec, Musculoskeletal Transplant Foundation, Rotation Medical, and Vericel; honoraria from Linvatec and Vericel; royalties from Linvatec; and is a paid associate editor for The American Journal of Sports Medicine. S.L.B. has received personal fees from Stryker and Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Testing apparatus used to simulate posterior instability. The humerus was displaced 1 cm posteriorly (arrow) while in 90° of flexion and 30° of internal rotation relative to the scapula. The bony 3D architecture without soft tissue is demonstrated on the right. 3D, three-dimensional.
Figure 2.
Figure 2.
Posterior opening wedge glenoid osteotomy created 2.5 cm medial to the glenohumeral joint space using a triangular wedge from the scapular spine and secured with 6-hole 2.7-mm T-plate (Smith & Nephew). Soft tissue repair was not performed in this figure to better allow for visualization of the osteotomy.
Figure 3.
Figure 3.
Mean peak resistance force, with standard error bars, for all test groups after 1 cm of posterior humeral displacement.
See this image and copyright information in PMC

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