Increasing Simulated Hill Sachs Lesion Size Decreases Glenohumeral Stability
20 slide(s) – 00:05:15 – English – 2009-07-05
Purpose: We hypothesized that glenohumeral joint stability will decrease with increasingly larger humeral head defects. Method: Humeral head defects were created in 9 cadaveric shoulders to simulate Hill Sachs defects. Defects represented 1/8, 3/8, 5/8, and 7/8 of the radius of the humeral head. Secondary factors included abduction angles of 45 degrees and 90 degrees, and rotations of 40 degrees internal,neutral, and 40 degrees external. Specimens were tested at each defect size sequentially from smallest to largest and at each of 6 conditions for all abduction and rotation combinations. Using a 6 degree-of-freedom robot, the humeral head was translated at 0.5 mm per second until dislocation in the anteroinferior direction at 45 degrees to the horizontal glenoid axis. Results: ANOVA demonstrated significant factors of rotation (p<0.001) and defect size (p<0.001). In 40 degrees external rotation, there was significant reduction of distance to dislocation compared with neutral and 40 degrees internal rotation (p<0.001). The 5/8 and 7/8 radius osteotomies demonstrated decreased distance to dislocation compared to the intact state (p<0.05 and p<0.001 respectively). There was no difference found between abduction angles. Post hoc analysis determined significant differences for each arm position. There was decreased distance to dislocation at the 5/8 radius osteotomy at 40 degrees external rotation with 90 degrees of abduction (p<0.05). For the 7/8 radius osteotomy at 90 degrees abduction, there was decrease distance to dislocation for neutral and 40 degrees external rotation (p<0.001). For the same osteotomy at 45 degrees abduction, there was decreased distance to dislocation at 40 degrees external rotation (p<0.001). With the humerus internally rotated, there was never a significant change in the distance to dislocation. Conclusion: Glenohumeral stability decreases at a 5/8 radius defect and was most pronounced in 40 degrees external rotation and at 90 degrees abduction. At a 7/8 radius humeral defect, there was further decrease in stability at both neutral and external rotation. Internal rotation always maintained baseline glenohumeral stability.