Ernstbrunner Lukas, Paszicsnyek Alexander, Vetter Maximilian, Waltenspül Manuel, Borbas Paul, Francis-Pester Fraser W, Hoy Gregory A, Ackland David C, Bouaicha Samy, Wieser Karl
Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Australia.
Department of Biomedical Engineering, University of Melbourne, Parkville, Australia.
Am J Sports Med. 2025 Oct;53(12):2963-2972. doi: 10.1177/03635465251365497. Epub 2025 Sep 3.
The extent to which excessive glenoid retroversion leads to increased glenohumeral contact pressures and whether these increases can be mitigated surgically is unknown.
To evaluate the effect of excessive glenoid retroversion and posterior iliac crest bone grafting (ICBG) with or without glenoid osteotomy on glenohumeral contact patterns.
Controlled laboratory study.
Six fresh-frozen shoulders had a posterior open-wedge glenoid osteotomy allowing glenoid retroversion to be set at 0°, 10°, and 20°. Four conditions were simulated consecutively on the same specimen at each retroversion angle: intact glenohumeral joint, posterior Bankart lesion, 20% posterior glenoid deficiency, and posterior ICBG (at 20° of retroversion; corrected to 10° and 0° of retroversion). The contact pattern for each specimen was evaluated in the jerk position (60° of glenohumeral anteflexion, 60° of internal rotation) by measuring mean and peak contact pressures (megapascals), peak contact pressure distance (millimeters), and mean contact area (square millimeters).
In the intact condition, retroversion of 20° resulted in a significant decrease in contact area but did not significantly affect contact pressure. Creating a posterior Bankart lesion and/or posterior glenoid deficiency showed a significant increase in mean and peak contact pressure at all 3 retroversion angles ( < .05). Correcting glenoid retroversion to 0° in combination with ICBG resulted in comparable contact area and mean and peak contact pressure of the intact condition ( > .05). At 10° and 20° of glenoid retroversion, ICBG resulted in significantly higher peak and mean contact pressure (mean not significantly different at 10°) and significantly lower contact area as compared with the intact condition ( < .05).
Glenohumeral contact patterns highly depend on the amount of glenoid retroversion and posterior labral and/or bony glenoid integrity. Only the combination of ICBG and glenoid osteotomy to correct glenoid retroversion to 0° resulted in glenohumeral contact patterns comparable to the native condition with 0° of retroversion.
The combined effect of posterior glenoid bone grafting and correcting excessive glenoid retroversion (20°) may correct abnormal glenohumeral contact patterns.
肩胛盂过度后倾导致盂肱关节接触压力增加的程度以及这种增加是否可通过手术减轻尚不清楚。
评估肩胛盂过度后倾以及有无肩胛盂截骨的髂后嵴骨移植（ICBG）对盂肱关节接触模式的影响。
对照实验室研究。
对六个新鲜冷冻肩关节进行后方开放楔形肩胛盂截骨，使肩胛盂后倾角度设定为0°、10°和20°。在每个后倾角度下，在同一标本上依次模拟四种情况：完整的盂肱关节、后方Bankart损伤、20%的肩胛盂后方缺损以及后方ICBG（后倾20°时；矫正至后倾10°和0°）。通过测量平均和峰值接触压力（兆帕）、峰值接触压力距离（毫米）以及平均接触面积（平方毫米），在急动位（盂肱前屈60°、内旋60°）评估每个标本的接触模式。
在完整状态下，20°后倾导致接触面积显著减小，但对接触压力无显著影响。造成后方Bankart损伤和/或肩胛盂后方缺损在所有三个后倾角度下均显示平均和峰值接触压力显著增加（P<0.05）。将肩胛盂后倾矫正至0°并结合ICBG，其接触面积以及平均和峰值接触压力与完整状态相当（P>0.05）。与完整状态相比，在肩胛盂后倾10°和20°时，ICBG导致峰值和平均接触压力显著更高（在10°时平均值无显著差异）且接触面积显著更小（P<0.05）。
盂肱关节接触模式高度依赖于肩胛盂后倾程度以及后方盂唇和/或肩胛盂骨质完整性。只有ICBG与肩胛盂截骨相结合将肩胛盂后倾矫正至0°，才会导致盂肱关节接触模式与后倾0°的自然状态相当。
肩胛盂后方植骨与矫正肩胛盂过度后倾（20°）的联合作用可能矫正异常的盂肱关节接触模式。
