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Abstract

Background: Hill-Sachs lesions are often present with recurrent shoulder instability and may be a cause of failed Bankart repair.

Hypothesis: Glenohumeral joint stability decreases with increasingly larger humeral head defects.

Study Design: Descriptive laboratory study.

Methods: Humeral head defects, 1/8, 3/8, 5/8, and 7/8 of the humeral head radius, were created in 8 human cadaveric shoulders, simulating Hill-Sachs defects. Testing positions included 45° and 90° of abduction and 40° of internal rotation, neutral, and 40° of external rotation. Testing occurred at each defect size sequentially from smallest to largest for all abduction and rotation combinations. The humeral head was translated at 0.5 mm/s 45° anteroinferiorly to the horizontal glenoid axis until dislocation. Distance to dislocation, defined as humeral head translation until it began to subluxate, was the primary outcome measure.

Results: Significant factors by ANOVA were rotation (P < .001) and defect size (P < .001). There was no difference for the 2 abduction angles. External rotation of 40° significantly reduced distance to dislocation compared with neutral and 40° internal rotation (P < .001). Osteotomies of 5/8 and 7/8 radius significantly decreased distance to dislocation over the intact state (P = .009 and P < .001, respectively). Post hoc analysis determined significant differences for the rotational positions. Decreased distance to dislocation occurred at 5/8 radius osteotomy at 40° external rotation with 90° of abduction (P = .008). For the 7/8 radius osteotomy at 90° abduction, there was a decreased distance to dislocation for neutral and 40° external rotation (P < .001); at 45° abduction, there was a decreased distance to dislocation at 40° external rotation (P < .001). With the humerus internally rotated, there was no significant change in distance to dislocation.

Conclusion: Glenohumeral stability decreases at a 5/8 radius defect in external rotation and abduction. At 7/8 radius, there was a further decrease in stability at neutral and external rotation.

Clinical Relevance: Defects of 5/8 the humeral head radius may require treatment to decrease the failure rate of shoulder instability repair.

Keywords

Hill-Sachs shoulder instability Bankart repair dislocation

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Effect of Humeral Head Defect Size on Glenohumeral Stability

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