Rodriguez Alexander, Baumann John, Bezold Will, Smith Conor, Thomas Dimitri, Cook James L, Smith Matthew J
Thompson Laboratory for Regenerative Orthopaedics, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
University of North Carolina Orthopedics and Sports Medicine at Lenoir, Kinston, NC, USA.
J Shoulder Elbow Surg. 2023 Feb;32(2):374-382. doi: 10.1016/j.jse.2022.08.027. Epub 2022 Oct 4.
Glenoid reconstruction is indicated for recurrent glenohumeral instability with significant glenoid bone deficiency. Coracoid autograft (Latarjet) and distal tibial osteochondral allograft (DTA) reconstructions have been used to successfully restore glenohumeral stability. Relative advantages and disadvantages associated with each reconstruction technique have been described. However, direct comparisons of functional glenohumeral biomechanics associated with Latarjet vs. DTA reconstruction are lacking. This study was designed to compare these 2 glenoid reconstruction techniques with respect to joint kinematics and cartilage pressure mapping using a robotic testing system.
In accordance with institutional review board policies, human cadaveric shoulders (n = 8) were cyclically tested in the neutral position and 90° of external rotation with 60° and 90° of abduction under a 45-N joint-compression load to measure clinically relevant translations, loads, and torques. Joint contact pressure maps were obtained under a 120-N joint-compression load using pressure mapping sensors. After confirming that a 25% anterior glenoid defect resulted in glenohumeral dislocation, testing was performed to compare 3 conditions: native intact glenoid, 25% anterior glenoid defect with Latarjet reconstruction, and 25% anterior glenoid defect with DTA reconstruction. Analyses of variance and t tests were used to analyze data with statistical significance set at P < .05.
Significant differences in anterior translation, inferior drawer, anterior drawer, compression loads, horizontal abduction, negative elevation (adduction), and external rotation torques during cyclical testing in 90° of external rotation with 60° and/or 90° of abduction were noted when comparing the 2 different glenoid bone reconstruction techniques to native, intact shoulders. The only significant difference between Latarjet and DTA reconstructions for measured translations, loads, and torques was a significantly higher absolute maximum compressive load for Latarjet compared to DTA at 60° of abduction.
Latarjet coracoid osseous autograft and distal tibial osteochondral allograft reconstructions of large (25%) glenoid bone defects prevent failure (dislocation) and are associated with significant glenohumeral kinematic differences that largely confer less translation, load, and torque on the joint in abduction when compared to the native state. These findings suggest that these 2 surgical techniques exhibit similar glenohumeral kinematics such that each provides adequate functional stability following anterior glenoid bone reconstruction. Joint compression load and articular contact pressure distribution may favor distal tibial osteochondral allograft reconstruction for treatment of large (25%) anterior glenoid bone defects associated with shoulder instability.
肩胛盂重建适用于伴有明显肩胛盂骨缺损的复发性肩肱关节不稳。喙突自体骨移植（拉塔热手术）和胫骨远端骨软骨异体移植（DTA）重建已被用于成功恢复肩肱关节稳定性。已描述了每种重建技术的相对优缺点。然而，缺乏对拉塔热手术与DTA重建相关的功能性肩肱关节生物力学的直接比较。本研究旨在使用机器人测试系统比较这两种肩胛盂重建技术在关节运动学和软骨压力映射方面的差异。
根据机构审查委员会的政策，对人体尸体肩关节（n = 8）在中立位以及外旋90°且外展60°和90°的情况下，在45 N的关节压缩负荷下进行循环测试，以测量临床相关的平移、负荷和扭矩。使用压力映射传感器在120 N的关节压缩负荷下获得关节接触压力图。在确认25%的肩胛盂前部缺损会导致肩肱关节脱位后，进行测试以比较3种情况：正常完整的肩胛盂、采用拉塔热手术重建的25%肩胛盂前部缺损以及采用DTA重建的25%肩胛盂前部缺损。采用方差分析和t检验分析数据，设定统计学显著性为P < .05。
将两种不同的肩胛盂骨重建技术与正常完整的肩关节进行比较时，发现在外旋90°且外展60°和/或90°的循环测试期间，在前向平移、下抽屉试验、前抽屉试验、压缩负荷、水平外展、负向抬高（内收）和外旋扭矩方面存在显著差异。拉塔热手术和DTA重建在测量的平移、负荷和扭矩方面的唯一显著差异是，在60°外展时，拉塔热手术的绝对最大压缩负荷显著高于DTA。
对于大的（25%）肩胛盂骨缺损，拉塔热喙突自体骨移植和胫骨远端骨软骨异体移植重建可防止失败（脱位），并且与显著的肩肱关节运动学差异相关，与自然状态相比，在外展时关节的平移、负荷和扭矩在很大程度上较小。这些发现表明，这两种手术技术表现出相似的肩肱关节运动学，因此在肩胛盂前部骨重建后每种技术都能提供足够的功能稳定性。关节压缩负荷和关节接触压力分布可能有利于胫骨远端骨软骨异体移植重建，用于治疗与肩部不稳相关的大的（25%）肩胛盂前部骨缺损。
