Biomechanical properties of transosseous bony Bankart repair in a cadaver model - 13/02/19

Doi : 10.1016/j.otsr.2018.10.022

Philippe Clavert ^a,^b,^c,^⁎ , Florence Aim ^d, Nicolas Bonnevialle ^e, Marine Arboucalot ^e, Matthieu Ehlinger ^a,^f, Thomas Bauer ^d
the
SOFCOT^g
^a Équipe 12 matériaux multi-échelles et biomécanique, institut de mécanique des fluides et des solides, laboratoire ICube, GEBOAS, UMR 7357, CNRS UMR 7357, 2–4, rue Boussingault, 67000 Strasbourg, France
^b D’anatomie normale, faculté de médecine, fédération de médecine translationnelle, FMTS, 4, rue Kirschleger, 67085 Strasbourg, France
^c Service de chirurgie du membre supérieur, hôpitaux universitaires de Strasbourg, CCOM, avenue Baumann, 67400 Illkirch, France
^d Service de chirurgie orthopédique, CHU Ambroise Paré, AP–HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France
^e Département de chirurgie orthopédique, hôpital Riquet, CHU de Toulouse, place Baylac, 31059 Toulouse, France
^f Service de chirurgie orthopédique et de traumatologie, hôpital universitaire de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg, France
^g French Society for Orthopedic and Trauma Surgery, 56, rue Boissonnade, 75014 Paris, France

^⁎Corresponding author at: faculté de médecine, institut d’anatomie normale, 4, rue Kirschleger, 67085 Strasbourg, France.France

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Abstract

Introduction

We compared two arthroscopic repair techniques to an intact shoulder using a biomechanical model of anterior shoulder dislocation with an anterior glenoid rim fracture (Ideberg IA fracture). We hypothesized that transosseous repair is sufficient to effectively stabilize the glenoid fracture. The primary objective was to define the mechanical properties of transosseous repair of an Ideberg IA fracture relative to an intact shoulder (control group). The secondary objective was to determine the contribution of supplemental anteroposterior screw fixation of the bone fragment.

Materials and methods

Fifteen fresh cadaver shoulders were divided into two groups: 5 specimens in the control group and 10 in the fracture fixation group, with sequential performance of transosseous repair followed by transosseous repair+screw fixation. A fracture at the inferior portion involving more than 30% of the glenoid's surface area was made.

Results

The load to failure was 457 N in the control group, 277 N in the transosseous repair group and 325 N in the transosseous repair+screw fixation group. The stiffness of the constructs was 26.2N/mm for the control group, 14.6N/mm for transosseous repair and 24.6N/mm for transosseous repair+screw fixation. The difference between the two repair techniques was significant for the load to failure (p=0.02) and stiffness (p=0.001).

Discussion/Conclusion

This study showed that transosseous repair restores the shoulder's anatomy but not the mechanical strength of the native glenoid. Adding screw fixation significantly improves the construct.