Basic scienceBiomechanical analysis of the modified Bristow procedure for anterior shoulder instability: is the bone block necessary?
Section snippets
Materials and methods
Eight cadaveric shoulders (4 left and 4 right shoulders from 6 male and 2 female cadavers with a mean age of 60 years) were prepared by removing the clavicle and major shoulder muscles, leaving the rotator cuff, capsule, coracoacromial ligament, and conjoined tendon intact. Three small reference screws were placed on the anterolateral edge of the acromion and the proximal humerus for measuring glenohumeral kinematics.
The scapula was secured to a mounting bracket, and the humerus was secured to
Rotational range of motion
After creation of a bony Bankart lesion, internal, external, and total range of motion increased significantly from the intact condition in both the scapular and coronal planes (P < .005 for all comparisons) (Table I). The increase in motion remained significantly increased from the intact condition after modified and soft tissue–only Bristow procedures in both planes (P < .01). There was no significant difference in range of motion between the modified and soft-tissue Bristow groups.
Discussion
In this biomechanical model, a Bankart lesion with 20% glenoid bone loss resulted in a significant increase in external rotation and overall range of motion. The modified Bristow procedure resulted in motion that was not statistically different from the intact condition in the scapular plane but was significantly increased in the modified Bristow condition in the coronal plane. The soft-tissue transfer condition resulted in significantly increased external rotation and total range of motion
Conclusions
The increase in external rotation observed in our instability model remained significantly increased from the intact condition in each repair condition. This suggests that nonanatomic reconstruction does not initially restrict joint motion. The data also show that translational stability can be restored in a 20% bone loss model without a bone block, suggesting the importance of the soft-tissue sling created by the conjoined tendon and subscapularis in the position of abduction and external
Disclaimer
Partial funding was provided by VA Rehabilitation Research and Development Merit Review and the John C. Griswold Foundation. The funding source did not play a role in the investigation.
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Biomechanical comparison of open Bankart repair vs. conjoint tendon transfer in a 10% anterior glenoid bone loss shoulder instability model
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2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryBankart Repair With Transferred Long Head of the Biceps Provides Better Biomechanical Effect Than Conjoined Tendon Transfer in Anterior Shoulder Instability With 20% Glenoid Defect
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All investigations were performed at the Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, CA.