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. 2024 Dec 24:66:1-7.
doi: 10.1016/j.jor.2024.12.021. eCollection 2025 Aug.

Non-screw glenoid augmentation constructs for shoulder instability with bone loss: A biomechanical assessment of static and elastic cerclage constructs

Kyle Paul  1 , John N Manfredi  2 , Mathew Hargreaves  2 , Mitchell K Messner  3 , Clay A Rahaman  2 , Brent Ponce  4 , Amit M Momaya  2 , Eugene Brabston  2
Affiliations

Non-screw glenoid augmentation constructs for shoulder instability with bone loss: A biomechanical assessment of static and elastic cerclage constructs

Kyle Paul et al. J Orthop. .

Abstract

Purpose: This study aims to compare the biomechanical performance of elastic and static suture-based cerclage systems to traditional screw constructs in the setting of modeled glenoid bony augmentation.

Methods: Biomechanical testing was conducted on polyurethane cellular foam blocks modeling a 20 % glenoid defect repaired with a coracoid graft. Constructs consisted of an elastic suture-based cerclage, static suture-based cerclage, and a two-screw construct. Biomechanical testing was performed on material testing system, using a 7-phase, 100 cycle per phase, 1Hz, sinusoidal cyclic loading protocol, following a stair-step pattern in load control. Failure for cyclic loading was assessed at 0.8 mm linear displacement. The absolute end level for load-to-failure was 7.0 mm.

Results: Static suture-based cerclage failed at 5-50 N (Cycles 2 through 4), 2-screw constructs failed at 25-50 N (Cycle 4), and elastic suture-based cerclage failed at 100-200N (Cycles 6 and 7). Elastic cerclage exhibited superior performance compared to static cerclage beginning in Cycle 2 (p = 0.0440) and compared to SOC 2-screw construct beginning in Cycle 4 (p = 0.0118). 2-screw construct exhibited superior stability performance compared to static cerclage beginning in Cycle 3 (p = 0.0001). Elastic cerclage reached failure at 558.141 ± 4.508 N, while 2-screw construct and static cerclage reached failure at 422.009 ± 24.998 N and 366.770 ± 66.653 N, respectively. Elastic cerclage demonstrated superior biomechanical stability in load-at-failure performance to static cerclage (p < 0.0001) and the screw construct (p < 0.0001), while static cerclage demonstrated inferior biomechanical stability to the screw construct (p = 0.0343).

Conclusion: This biomechanical study comparing the performance of elastic cable and static suture tape cerclage fixation methods identified that the elastic cable cerclage exhibits a higher load-at-failure and less displacement under repetitive stress. In addition, elastic cable cerclage fixation exhibits greater strength and construct rigidity than traditional metal screw fixation.

Keywords: Biomechanical stability; Elastic cerclage; Glenoid augmentation; Suture-based cerclage systems.

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Conflict of interest statement

The following authors have the stated interests: Amit Momaya: CONMED Corporation- Other Professional Activities; Eugene Brabston: EBSCO-Editorial or governing board, Link Orthopaedics-Paid consultant, Orthopaedic Design NA-Paid consultant; Aaron Casp:American Orthopaedic Society for Sports Medicine-Board or committee member, Arthrex, Inc-Paid consultant; Brent Ponce: American Orthopaedic Association: Board or committee member, Help Lightning: Stock or stock Options, Orthopaedic Designs North America Inc.: Paid consultant, Smith & Nephew: Paid consultant, Stryker: IP royalties; Paid consultant; Paid presenter or speaker.

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