Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model

Robert U. Hartzler, Christopher N.H. Bui, Woong-Kyo Jeong, Masaki Akeda, Alex Peterson, Michelle McGarry, Patrick J. Denard, Stephen S. Burkhart, Thay Q. Lee

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m vs 7.0 N/m and 10.0 N/m vs 5.0 N/m, P =.0002) and for on-track lesions at end-range rotation (10.1 N/m vs 5.0 N/m, P =.0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m vs 7.0 N/m, P >.99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.

Original languageEnglish
Pages (from-to)2466-2476
Number of pages11
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume32
Issue number12
DOIs
Publication statusPublished - 2016 Dec 1
Externally publishedYes

Fingerprint

Shoulder Joint
Bone and Bones
Bankart Lesions
Bursitis
Decision Making

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model. / Hartzler, Robert U.; Bui, Christopher N.H.; Jeong, Woong-Kyo; Akeda, Masaki; Peterson, Alex; McGarry, Michelle; Denard, Patrick J.; Burkhart, Stephen S.; Lee, Thay Q.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 32, No. 12, 01.12.2016, p. 2466-2476.

Research output: Contribution to journalArticle

Hartzler, Robert U. ; Bui, Christopher N.H. ; Jeong, Woong-Kyo ; Akeda, Masaki ; Peterson, Alex ; McGarry, Michelle ; Denard, Patrick J. ; Burkhart, Stephen S. ; Lee, Thay Q. / Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model. In: Arthroscopy - Journal of Arthroscopic and Related Surgery. 2016 ; Vol. 32, No. 12. pp. 2466-2476.
@article{087f85b2f15c42fb9cde5e4bb63c5766,
title = "Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model",
abstract = "Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15{\%} with on-track (15{\%}) and off-track (30{\%}) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5{\%}) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100{\%}) at end-range rotation and in 6 (75{\%}) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67{\%}) at mid-range rotation but was prevented in zero of 8 (0{\%}) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100{\%}). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m vs 7.0 N/m and 10.0 N/m vs 5.0 N/m, P =.0002) and for on-track lesions at end-range rotation (10.1 N/m vs 5.0 N/m, P =.0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m vs 7.0 N/m, P >.99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15{\%} glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.",
author = "Hartzler, {Robert U.} and Bui, {Christopher N.H.} and Woong-Kyo Jeong and Masaki Akeda and Alex Peterson and Michelle McGarry and Denard, {Patrick J.} and Burkhart, {Stephen S.} and Lee, {Thay Q.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.arthro.2016.04.030",
language = "English",
volume = "32",
pages = "2466--2476",
journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",
issn = "0749-8063",
publisher = "W.B. Saunders Ltd",
number = "12",

}

TY - JOUR

T1 - Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model

AU - Hartzler, Robert U.

AU - Bui, Christopher N.H.

AU - Jeong, Woong-Kyo

AU - Akeda, Masaki

AU - Peterson, Alex

AU - McGarry, Michelle

AU - Denard, Patrick J.

AU - Burkhart, Stephen S.

AU - Lee, Thay Q.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m vs 7.0 N/m and 10.0 N/m vs 5.0 N/m, P =.0002) and for on-track lesions at end-range rotation (10.1 N/m vs 5.0 N/m, P =.0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m vs 7.0 N/m, P >.99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.

AB - Purpose To validate the glenoid track concept in a cadaveric bipolar bone loss model and to test whether “on-track” and “off-track” lesions can be stabilized with Bankart repair (BR) with or without Hill-Sachs remplissage (HSR). Methods Eight fresh-frozen cadaveric shoulders were tested in a custom apparatus with passive axial rotation and then progressive translational loading (10 to 40 N) at mid-range (60°) and end-range external rotation (90°). Injury conditions included glenoid bone loss of 15% with on-track (15%) and off-track (30%) Hill-Sachs lesions. Repair conditions included BR with HSR and BR without HSR. Results For on-track lesions, engagement occurred with translation testing in one shoulder (12.5%) at end-range rotation. After BR, engagement was prevented for this shoulder. For off-track lesions, engagement with translation testing occurred in 8 shoulders (100%) at end-range rotation and in 6 (75%) at mid-range rotation. After BR, engagement was prevented in 4 of 6 engaging shoulders (67%) at mid-range rotation but was prevented in zero of 8 (0%) at end-range rotation. Adding HSR prevented engagement in all 14 engaging shoulders with off-track lesions (100%). BR with HSR resulted in supraphysiological stiffness for off-track lesions at mid- and end-range rotation (13.3 N/m vs 7.0 N/m and 10.0 N/m vs 5.0 N/m, P =.0002) and for on-track lesions at end-range rotation (10.1 N/m vs 5.0 N/m, P =.0002). Stiffness of BR with HSR was not different from the intact shoulder for on-track lesions at mid-range rotation (7.2 N/m vs 7.0 N/m, P >.99). Conclusions The patterns of engagement of Hill-Sachs lesions with a 15% glenoid defect in this model give support to the glenoid track concept. BR plus remplissage resulted in supraphysiological shoulder stiffness but was necessary to prevent engagement of off-track bipolar bone lesions. Clinical Relevance This biomechanical study provides evidence to aid in surgical decision making by examining the effects of bipolar bone loss and soft-tissue reconstruction on shoulder stability.

UR - http://www.scopus.com/inward/record.url?scp=85000838169&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85000838169&partnerID=8YFLogxK

U2 - 10.1016/j.arthro.2016.04.030

DO - 10.1016/j.arthro.2016.04.030

M3 - Article

C2 - 27432588

AN - SCOPUS:85000838169

VL - 32

SP - 2466

EP - 2476

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

SN - 0749-8063

IS - 12

ER -