Background: Augmentation of anterior glenoid defects with bone graft can improve shoulder stability and reduce the risk of redislocation. Several characteristics of the scapular spine may make it a suitable harvest site, avoiding the disadvantages associated with other glenoid augmentation procedures.
Purpose: To evaluate the capacity of scapular spine autograft to restore the stabilizing joint-reaction forces of the shoulder in simulated scenarios of bony anterior shoulder instability.
Study Design: Controlled laboratory study.
Methods: We obtained 6 matched pairs of fresh-frozen cadaveric shoulders. Skin, subcutaneous tissues, and non-rotator cuff muscles were removed from the specimens, leaving intact the rotator cuff musculature and shoulder capsule. A customized testing device was used to translate the humerus 1 cm anteriorly on the glenoid under 25 N of axial compression force. The peak joint-reaction force of the glenohumeral joint was then measured under 3 conditions: (1) specimen with intact glenoid, (2) specimen after a bone defect measuring 25% of the maximal width of the glenoid was made in the anteroinferior glenoid, and (3) specimen after size-matched glenoid augmentation with a scapular spine tricortical autograft. The primary outcome was the change in peak joint-reaction forces between the defect state and augmented state.
Results: One matched pair was removed from final analysis secondary to anatomic concerns that undermined the accuracy of test results. Among the 10 remaining specimens, all showed a significant decrease in peak joint-reaction force after the glenoid defect was created compared with the intact state ( P < .001). All remaining specimens showed an increase in peak joint-reaction force in the augmented state compared with the defect state ( P < .001). On average, the augmented state restored 81% of the peak reaction force of the glenohumeral joint compared with the intact state, a nonsignificant difference ( P = .07).
Conclusion: The study findings indicated that autograft harvested from the scapular spine increased the bony restraint to anterior shoulder dislocation in shoulders with glenoid bone loss.
Clinical Relevance: The scapular spine is an alternative for bony augmentation of glenoid defects in shoulder instability.
Bibliographical noteFunding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: B.J.N. has received education payments from Arthrex and consulting fees from Marrow Access Technologies. R.A.A. has received research funding from Arthrex, education payments from Don-Joy, and consulting fees and stock options from Bio-rez. M.A.T. has received grant support from DJO and hospitality payments from Aesculap. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
© The Author(s) 2022.
- glenoid augmentation
- scapular spine
- shoulder instability
PubMed: MeSH publication types
- Journal Article