Effect of Anterior Glenoid Chondrolabral Defects on Anterior Glenohumeral Stability: A Biomechanical Study.

Background: It is well known that glenoid osseous defects >13.5% of the glenoid width critically destabilize the shoulder, as do labral tears. Chondrolabral defects often occur with anterior dislocation of the shoulder. It is unclear whether glenoid chondrolabral defects contribute to shoulder stability and, if so, at what size they become critical. Purpose/Hypothesis: The purpose of this study was to determine the effect of incremental chondrolabral defect sizes on anterior shoulder stability in the setting of labral deficiency. The hypothesis was that chondrolabral defects ≥13.5% of the glenoid width will decrease anterior shoulder stability. Study Design: Controlled laboratory study. Methods: This controlled laboratory study tested 12 fresh-frozen shoulders. Specimens were attached to a custom testing device in abduction and neutral rotation with 50-N compression applied to the glenoid. The humeral head was translated 10 mm anterior, anteroinferior, and anterosuperior with the conditions of intact cartilage and labrum and anterior full-thickness chondrolabral defects of 3-, 6-, and 9-mm width. Translation force was measured continuously. Peak translation force divided by 50-N compressive force defined the stability ratio. Data were analyzed using analysis of variance. Results: The anterior stability ratio decreased between the intact state (36% ± 7%) and all defects ≥3 mm (≤32% ± 8%; P ≤ .023). The anteroinferior stability ratio decreased between the intact state (52% ± 7%) and all defects ≥3 mm (≤47% ± 7%; P ≤ .006). The anterosuperior stability ratio decreased between the intact state (36% ± 4%) and all defects ≥6 mm (≤33% ± 4%; P ≤ .006). A 3-mm defect equated to 10% of the glenoid width. There were moderate to strong negative correlations between chondrolabral defect size and stability ratio in the anterior, anteroinferior, and anterosuperior directions (r = -0.79, -0.63, and -0.58, respectively; P ≤ .001). There were moderate to strong negative correlations between the percentage of glenoid chondrolabral defect size to the glenoid width and the stability percentage in all directions (r = -0.81, -0.63, and -0.61; P ≤ .001). Conclusion: An anterior glenoid chondrolabral defect ≥3 mm (>10% of the glenoid width) significantly decreased anterior and anteroinferior stability. Chondrolabral defect size negatively correlated with stability. Clinical Relevance: To fully restore glenohumeral stability, in addition to labral repair, it may be necessary to reconstruct chondrolabral defects as small as 3 mm (10% of the glenoid width).

Reverse total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study.

BACKGROUND: Optimal implant placement in reverse total shoulder arthroplasty (rTSA) remains controversial. Specifically, the optimal glenoid inclination is unknown. Therefore, a cadaveric shoulder simulator with 3-dimentional human motion specific to rTSA was used to study joint contact and muscle forces as a function of glenoid component inclination. METHODS: Eight human cadaver shoulders were tested before and after rTSA implantation. Scapular plane abduction kinematics from control subjects and those with rTSA drove a cadaveric shoulder simulator with 3-dimentional scapulothoracic and glenohumeral motion. Glenoid inclination varied from -20° to +20°. Outputs included compression, superior-inferior (S/I) shear, and anterior-posterior shear forces from a 6° of freedom load cell in the joint, and deltoid and rotator cuff muscle forces. Data were evaluated with statistical parametric mapping and t-tests. RESULTS: Inferior glenoid inclination (-) reduced S/I shear by up to 125% relative to superior inclination, with similar compression to the neutral condition (0°). Superior inclinations (+) increased the S/I shear force by approximately the same magnitude, yet decreased compression by 25% in the most superior inclination (+20°). There were few differences in deltoid or rotator cuff forces due to inclination. Only the middle deltoid decreased by approximately 7% for the most inferior inclination (-20°). Compared with native shoulders, the neutral (0°) rTSA inclination showed reduced forces of 30%-75% in the anterior deltoid and a trend toward decreased forces in the middle deltoid. Force demands on the rotator cuff varied as a function of elevation, with a trend toward increased forces in rTSA at peak glenohumeral elevation. CONCLUSIONS: Inferior inclination reduces superior shear forces, without influencing compression. Superior inclination increased S/I shear, while decreasing compression, which may be a source of component loosening and joint instability after rTSA. Inferior inclination of the rTSA glenoid may reduce the likelihood of glenoid loosening by reducing the magnitude of cyclic shear and compressive loading during arm elevation activities, although this may be altered by specific-subject body habitus and motion. These factors are especially important in revision rTSA or glenoid bone grafting where there is already a 3-fold increase in glenoid baseplate loosening vs. primary rTSA.

Anatomic total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study.

BACKGROUND: Although typically favorable in outcome, anatomic total shoulder arthroplasty (aTSA) can require long-term revision. The most common cause for revision is glenoid loosening, which may result from eccentric cyclic forces and joint translations. "Rocking" of the glenoid component may be exacerbated by the joint geometry, such as glenoid inclination and version. Restoration of premorbid glenoid inclination may be preferable, although laboratory and computational models indicate that both superior inclination and inferior inclination have benefits. This discrepancy may arise because previous studies were limited by a lack of physiological conditions to test inclination. Therefore, a cadaveric shoulder simulator with 3-dimensional human motion was used to study joint contact and muscle forces with isolated changes in glenoid inclination. METHODS: Eight human cadaveric shoulders were tested before and after aTSA. Scapular-plane abduction kinematics from human subjects were used to drive a cadaveric shoulder simulator with 3-dimensional scapulothoracic and glenohumeral motion. Glenoid inclination was varied from -10° to +20°, whereas compressive, superior-inferior shear, and anterior-posterior shear forces were collected with a 6-df load cell during motion. Outputs also included muscle forces of the deltoid and rotator cuff. Data were evaluated with statistical parametric mapping repeated-measures analysis of variance and t tests. RESULTS: Inferior glenoid inclination (-10°) reduced both compressive and superior-inferior shear forces vs. neutral 0° inclination by up to 40%, and even more when compared with superior inclination (P < .001). Superior inclinations (+10° and +20°) tended to increase deltoid and rotator cuff forces vs. neutral 0° inclination or inferior inclination, on the order of 20%-40% (P ≤ .045). All force metrics except anterior-posterior shear were lowest for inferior inclination. Most aTSA muscle forces for neutral 0° inclination were not significantly different from native shoulders and decreased 45% and 15% in the posterior deltoid and supraspinatus, respectively (P ≤ .003). Joint translations were similar to prior reports in aTSA patients and did not differ between any inclinations or compared with native shoulders. Joint reaction forces were similar to those observed in human subjects with instrumented aTSA implants, providing confidence in the relative magnitude of our results. CONCLUSIONS: Inferior inclination reduces overall forces in the shoulder. Superior inclinations increase the muscle effort required for the shoulder to achieve similar motion, thus increasing the forces exerted on the glenoid component. These results suggest that a preference toward aTSA glenoid components in inferior inclination may reduce the likelihood of glenoid loosening by reducing excessive muscle and joint contact forces.

In Vitro Simulation of Shoulder Motion Driven by Three-Dimensional Scapular and Humeral Kinematics.

In vitro simulation of three-dimensional (3D) shoulder motion using in vivo kinematics obtained from human subjects allows investigation of clinical conditions in the context of physiologically relevant biomechanics. Herein, we present a framework for laboratory simulation of subject-specific kinematics that combines individual 3D scapular and humeral control in cadavers. The objectives were to: (1) robotically simulate seven healthy subject-specific 3D scapulothoracic and glenohumeral kinematic trajectories in six cadavers, (2) characterize system performance using kinematic orientation accuracy and repeatability, and muscle force repeatability metrics, and (3) analyze effects of input kinematics and cadaver specimen variability. Using an industrial robot to orient the scapula range of motion (ROM), errors with repeatability of ±0.1 mm and <0.5 deg were achieved. Using a custom robot and a trajectory prediction algorithm to orient the humerus relative to the scapula, orientation accuracy for glenohumeral elevation, plane of elevation, and axial rotation of <3 deg mean absolute error (MAE) was achieved. Kinematic accuracy was not affected by varying input kinematics or cadaver specimens. Muscle forces over five repeated setups showed variability typically <33% relative to the overall simulations. Varying cadaver specimens and subject-specific human motions showed effects on muscle forces, illustrating that the system was capable of differentiating changes in forces due to input conditions. The anterior and middle deltoid, specifically, showed notable variations in patterns across the ROM that were affected by subject-specific motion. This machine provides a platform for future laboratory studies to investigate shoulder biomechanics and consider the impacts of variable input kinematics from populations of interest, as they can significantly impact study outputs and resultant conclusions.