The Use of the Anterior Labral Circumferential Onlay Technique to Reconstruct the Anterior Labrum and Biomechanically Restore Glenohumeral Joint Stability.

Autor:	Dey Hazra ME; Steadman Philippon Research Institute, Vail, Colorado, USA.; Private practice of Dr. Ulf Kuhlee, Berlin, Germany., Dey Hazra RO; Private practice of Dr. Ulf Kuhlee, Berlin, Germany.; Department for Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité - University Medicine Berlin, Berlin, Germany., Brady AW; Steadman Philippon Research Institute, Vail, Colorado, USA., Ganokroj P; Steadman Philippon Research Institute, Vail, Colorado, USA.; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand., Brown JR; Steadman Philippon Research Institute, Vail, Colorado, USA., Garcia AR; Steadman Philippon Research Institute, Vail, Colorado, USA., Drumm AH; Steadman Philippon Research Institute, Vail, Colorado, USA., Millett PJ; Steadman Philippon Research Institute, Vail, Colorado, USA.; The Steadman Clinic, Vail, Colorado, USA.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2024 Dec 02; Vol. 12 (12), pp. 23259671241271529. Date of Electronic Publication: 2024 Dec 02 (Print Publication: 2024).
DOI:	10.1177/23259671241271529
Abstrakt:	Background: A labral injury contributes to glenohumeral instability. The Anterior Labral Circumferential Onlay Technique (ALCOT) reconstructs the labrum using the long head of the biceps tendon. Hypothesis: The ALCOT would restore glenohumeral joint stability in a cadaveric model without glenoid bone loss (1) comparable to the native state and (2) comparable to the Latarjet procedure. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a 6 degrees of freedom robotic arm in 5 consecutive states: (1) native, (2) capsular repair, (3) labral tear, (4) ALCOT, and (5) Latarjet procedure. Biomechanical testing consisted of 80 N of anteroinferior force and 50 N of compression in 90° of humerothoracic abduction. Lateral displacement of the humeral head and the force ratio during a dislocation were measured. Results: The mean lateral translation of the humeral head during a dislocation in the native state was 6.5 ± 2.2 mm and decreased to 5.4 ± 2.4 mm in the labral tear state ( P < .001). The mean lateral translation of the humeral head was restored to 6.4 ± 2.2 mm ( P > .99) with the ALCOT, showing no difference from the native state. The Latarjet procedure restored the mean force ratio during a dislocation to 1.3 ± 0.6 but failed to restore lateral translation, with a value of 5.6 ± 2.8 mm ( P = .003 vs native; P = .94 vs labral tear). The mean force ratio was 1.8 ± 0.1 in the native state, decreased to 1.1 ± 0.4 in the labral tear state, and was 1.4 ± 0.4 ( P < .27) with the ALCOT, showing no difference from the native state. Conclusion: The ALCOT is a novel technique for labral reconstruction that may have a role in the treatment of anterior glenohumeral instability in the setting of a deficient labrum without bone loss. In this study, the ALCOT restored the force ratio and lateral translation of the humeral head compared to the native state. The Latarjet procedure restored the force ratio but not lateral translation of the humeral head compared to the native state. Clinical Relevance: This study proposes and biomechanically validates the ALCOT as a surgical technique for labral reconstruction that may have a role in treating patients with chronic anterior shoulder instability in the setting of a deficient labrum. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study received partial support from Arthrex for in-kind products supplied. P.J.M. has received a royalty or license from Arthrex, consulting fees from Arthrex, and nonconsulting fees from Arthrex. 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) 2024.)
Databáze:	MEDLINE
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