title: Posteroinferior glenoplasty can change glenoid shape and increase the mechanical stability of the shoulder.
abstract: The treatment of recurrent posterior glenohumeral instability remains an unsolved clinical problem. Although various types of capsulorraphy have been advocated, outcome studies indicate that it is difficult to achieve a balance between stability and mobility. Alterations of the bony glenoid for posterior instability have been proposed, but are not well understood from a mechanical perspective. This investigation had 2 purposes: (1) to determine in a cadaver model if posteroinferior glenoplasty can change the shape of the glenoid, and (2) to determine if altering the shape of the glenoid can increase the mechanical stability of the glenohumeral joint. We determined the effective glenoid shape in 7 normal cadaver glenoids by tracking the path of the center of the humeral head as it was translated across the glenoid face in 8 different directions. These determinations enabled us to calculate the maximum effective slope of the glenoid in each direction. We then determined the mechanical stability of the glenoids in each of the 8 directions by measuring the tangential force required to dislocate the shoulder under a 50-N compressive load. The ratio of the dislocating force to the compressive load was defined as the stability ratio. All measurements were repeated after a standardized posteroinferior glenoplasty was performed. Posteroinferior glenoplasty increased the posteroinferior glenoid depth from 3.8 +/- 0.6 mm to 7.0 +/- 1.8 mm and shifted the center of the humeral head an average of 2.2 mm anteriorly and 1.8 mm superiorly. These changes in dimension could be directly visualized as an immediate mechanical consequence of the glenoplasty procedure, particularly because of the insertion of the bone wedge. Glenoplasty increased the posteroinferior glenoid slope from 0.55 +/- 0.07 to 0.83 +/- 0.12 and increased the posteroinferior stability ratio from 0.47 +/- 0.10 to 0.81 +/- 0.17. This is a more than 70% increase in the tangential force that can be resisted before dislocation. The increase can be quantitatively understood as a direct mechanical consequence of the altered shape of the glenoid concavity. These numbers indicate that, in this cadaveric model, posteroinferior glenoplasty results in defined changes in the effective glenoid shape and in the mechanical stability of the glenohumeral joint. However, this study does not establish the role of this procedure in the clinical management of posterior glenohumeral instability.
authors.affiliation: Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle 98195-6500, USA.
authors.forename: M H
authors.initials: MH
authors.lastname: Metcalf
authors.forename: D G
authors.initials: DG
authors.lastname: Duckworth
authors.forename: S B
authors.initials: SB
authors.lastname: Lee
authors.forename: J A
authors.initials: JA
authors.lastname: Sidles
authors.forename: K L
authors.initials: KL
authors.lastname: Smith
authors.forename: D T
authors.initials: DT
authors.lastname: Harryman
authors.forename: F A
authors.initials: FA
authors.lastname: Matsen
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*