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Biomechanical Analysis of Coracoid Stability After Coracoplasty: How Low Can You Go?
BACKGROUND: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impingement. To date, there is no consensus on how much of the coracoid can be resected with an arthroscopic burr without compromising its stability. PURPOSE: To determine the maximum amount of the coracoid tha...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951046/ https://www.ncbi.nlm.nih.gov/pubmed/35340899 http://dx.doi.org/10.1177/23259671221077947 |
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author | Heilmann, Lukas F. Sussiek, Julia Raschke, Michael J. Langer, Martin F. Frank, Andre Wermers, Jens Michel, Philipp A. Dyrna, Felix Schliemann, Benedikt Katthagen, J. Christoph |
author_facet | Heilmann, Lukas F. Sussiek, Julia Raschke, Michael J. Langer, Martin F. Frank, Andre Wermers, Jens Michel, Philipp A. Dyrna, Felix Schliemann, Benedikt Katthagen, J. Christoph |
author_sort | Heilmann, Lukas F. |
collection | PubMed |
description | BACKGROUND: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impingement. To date, there is no consensus on how much of the coracoid can be resected with an arthroscopic burr without compromising its stability. PURPOSE: To determine the maximum amount of the coracoid that can be resected during arthroscopic coracoplasty without leading to coracoid fracture or avulsion of the conjoint tendon during simulated activities of daily living (ADLs). STUDY DESIGN: Controlled laboratory study. METHODS: A biomechanical cadaveric study was performed with 24 shoulders (15 male, 9 female; mean age, 81 ± 7.9 years). Specimens were randomized into 3 treatment groups: group A (native coracoid), group B (3-mm coracoplasty), and group C (5-mm coracoplasty). Coracoid anatomic measurements were documented before and after coracoplasty. The scapula was potted, and a traction force was applied through the conjoint tendon. The stiffness and load to failure (LTF) were determined for each specimen. RESULTS: The mean coracoid thicknesses in groups A through C were 7.2, 7.7, and 7.8 mm, respectively, and the mean LTFs were 428 ± 127, 284 ± 77, and 159 ± 87 N, respectively. Compared with specimens in group A, a significantly lower LTF was seen in specimens in group B (P = .022) and group C (P < .001). Postoperatively, coracoids with a thickness ≥4 mm were able to withstand ADLs. CONCLUSION: While even a 3-mm coracoplasty caused significant weakening of the coracoid, the individual failure loads were higher than those of the predicted ADLs. A critical value of 4 mm of coracoid thickness should be preserved to ensure the stability of the coracoid process. CLINICAL RELEVANCE: In correspondence with the findings of this study, careful preoperative planning should be used to measure the maximum reasonable amount of coracoplasty to be performed. A postoperative coracoid thickness of 4 mm should remain. |
format | Online Article Text |
id | pubmed-8951046 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-89510462022-03-26 Biomechanical Analysis of Coracoid Stability After Coracoplasty: How Low Can You Go? Heilmann, Lukas F. Sussiek, Julia Raschke, Michael J. Langer, Martin F. Frank, Andre Wermers, Jens Michel, Philipp A. Dyrna, Felix Schliemann, Benedikt Katthagen, J. Christoph Orthop J Sports Med Article BACKGROUND: Arthroscopic coracoplasty is a procedure for patients affected by subcoracoid impingement. To date, there is no consensus on how much of the coracoid can be resected with an arthroscopic burr without compromising its stability. PURPOSE: To determine the maximum amount of the coracoid that can be resected during arthroscopic coracoplasty without leading to coracoid fracture or avulsion of the conjoint tendon during simulated activities of daily living (ADLs). STUDY DESIGN: Controlled laboratory study. METHODS: A biomechanical cadaveric study was performed with 24 shoulders (15 male, 9 female; mean age, 81 ± 7.9 years). Specimens were randomized into 3 treatment groups: group A (native coracoid), group B (3-mm coracoplasty), and group C (5-mm coracoplasty). Coracoid anatomic measurements were documented before and after coracoplasty. The scapula was potted, and a traction force was applied through the conjoint tendon. The stiffness and load to failure (LTF) were determined for each specimen. RESULTS: The mean coracoid thicknesses in groups A through C were 7.2, 7.7, and 7.8 mm, respectively, and the mean LTFs were 428 ± 127, 284 ± 77, and 159 ± 87 N, respectively. Compared with specimens in group A, a significantly lower LTF was seen in specimens in group B (P = .022) and group C (P < .001). Postoperatively, coracoids with a thickness ≥4 mm were able to withstand ADLs. CONCLUSION: While even a 3-mm coracoplasty caused significant weakening of the coracoid, the individual failure loads were higher than those of the predicted ADLs. A critical value of 4 mm of coracoid thickness should be preserved to ensure the stability of the coracoid process. CLINICAL RELEVANCE: In correspondence with the findings of this study, careful preoperative planning should be used to measure the maximum reasonable amount of coracoplasty to be performed. A postoperative coracoid thickness of 4 mm should remain. SAGE Publications 2022-02-28 /pmc/articles/PMC8951046/ /pubmed/35340899 http://dx.doi.org/10.1177/23259671221077947 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Heilmann, Lukas F. Sussiek, Julia Raschke, Michael J. Langer, Martin F. Frank, Andre Wermers, Jens Michel, Philipp A. Dyrna, Felix Schliemann, Benedikt Katthagen, J. Christoph Biomechanical Analysis of Coracoid Stability After Coracoplasty: How Low Can You Go? |
title | Biomechanical Analysis of Coracoid Stability After Coracoplasty: How
Low Can You Go? |
title_full | Biomechanical Analysis of Coracoid Stability After Coracoplasty: How
Low Can You Go? |
title_fullStr | Biomechanical Analysis of Coracoid Stability After Coracoplasty: How
Low Can You Go? |
title_full_unstemmed | Biomechanical Analysis of Coracoid Stability After Coracoplasty: How
Low Can You Go? |
title_short | Biomechanical Analysis of Coracoid Stability After Coracoplasty: How
Low Can You Go? |
title_sort | biomechanical analysis of coracoid stability after coracoplasty: how
low can you go? |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951046/ https://www.ncbi.nlm.nih.gov/pubmed/35340899 http://dx.doi.org/10.1177/23259671221077947 |
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