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Glenoid Rim Anatomy: Risk for Glenoid Vault Perforation During Labral Repair.

Levy YD, Williamson M, Flores-Hernandez C, D'Lima DD, Hoenecke HR - Orthop J Sports Med (2014)

Bottom Line: Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face.The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid.A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.

View Article: PubMed Central - PubMed

Affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.

ABSTRACT

Background: Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes.

Purpose: To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation.

Study design: Descriptive laboratory study.

Methods: Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face.

Results: Progressing in the clockwise direction, beginning at the 12:00 position, the safe insertion ranges (mean ± SD ) were 55.9° ± 10.6°, 63.6° ± 17.6°, 47.7° ± 9.1°, 46.1° ± 8°, 73.9° ± 9.7°, 40.9° ± 6.5°, 40.4° ± 7.4°, and 39.9° ± 7.1°, respectively. The optimal insertion angles were 47.9° ± 7.6°, 53.1° ± 10.9°, 35.0° ± 4.4°, 42.4° ± 4.9°, 60.9° ± 8.4°, 36.6° ± 5.9°, 31.2° ± 4.9°, 34.8° ± 4.6°, respectively.

Conclusion: Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face. The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid. A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.

Clinical relevance: Proper arthroscopic technique resulting in anchor insertion at the correct angle, depth, and location will prevent anchor-related glenohumeral complications such as glenoid perforation, cartilage damage, persistent pain, decreased range of motion, and failure of the reconstruction.

No MeSH data available.


Related in: MedlinePlus

(A) Schematic illustration of the glenoid clockface positions: 12:00, superior position; 3:00, anterior position; 6:00, inferior position; 9:00, posterior position. The lines represent the location of the simulated glenoid cuts and anchor insertion sites. (B) Cross section from 12:00 to 6:00. Note the superior protrusion of the glenoid rim at 12:00 and the continuation with the neck at 6:00. (C) Cross section from 3:00 to 9:00. Note the shelf-like protrusion of the glenoid rim from the glenoid neck at 9:00 and the linear continuation of the rim with the neck at 3:00. (D) Cross section from 4:30 to 10:30. The glenoid bony morphology resembles the cross section morphology of the 3:00 to 9:00 position; however, a slight increase in glenoid rim protrusion was noted at the 10:30 position. (E, F) Cross section at the 1:30 position demonstrated 2 variations: (E) a step-like appearance of the glenoid coracoid junction and (F) a continuous appearance of the glenoid coracoid junction.
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fig1-2325967114556257: (A) Schematic illustration of the glenoid clockface positions: 12:00, superior position; 3:00, anterior position; 6:00, inferior position; 9:00, posterior position. The lines represent the location of the simulated glenoid cuts and anchor insertion sites. (B) Cross section from 12:00 to 6:00. Note the superior protrusion of the glenoid rim at 12:00 and the continuation with the neck at 6:00. (C) Cross section from 3:00 to 9:00. Note the shelf-like protrusion of the glenoid rim from the glenoid neck at 9:00 and the linear continuation of the rim with the neck at 3:00. (D) Cross section from 4:30 to 10:30. The glenoid bony morphology resembles the cross section morphology of the 3:00 to 9:00 position; however, a slight increase in glenoid rim protrusion was noted at the 10:30 position. (E, F) Cross section at the 1:30 position demonstrated 2 variations: (E) a step-like appearance of the glenoid coracoid junction and (F) a continuous appearance of the glenoid coracoid junction.

Mentions: We performed a high-resolution computed tomography scan (0.625-mm axial resolution) of cadaveric shoulders. After 3-dimensional (3D) reconstruction of the scapulae (in MIMICS; Materialise), an evaluation of the glenoid face was performed, and specimens with any abnormality such as dysplasia, fracture, and bone loss due to arthritic changes were excluded. A total of 30 unpaired normal scapulae (16 left, 14 right) were selected for this study. A glenoid face was oriented to that of a clock, with 12:00 denoting the superior position, 3:00 the anterior position, 6:00 the inferior position, and 9:00 the posterior position. A vertical line was drawn on the glenoid face from 12:00 to 6:00 to measure the height of the glenoid. A perpendicular line to the midpoint of the vertical line was generated from 9:00 to 3:00, passing through the center of the glenoid width to define the center of the glenoid. From the center of the glenoid, a 45° angle was generated to define the 1:30, 4:30, 7:30, and 10:30 positions on the glenoid clockface (Figure 1A).


Glenoid Rim Anatomy: Risk for Glenoid Vault Perforation During Labral Repair.

Levy YD, Williamson M, Flores-Hernandez C, D'Lima DD, Hoenecke HR - Orthop J Sports Med (2014)

(A) Schematic illustration of the glenoid clockface positions: 12:00, superior position; 3:00, anterior position; 6:00, inferior position; 9:00, posterior position. The lines represent the location of the simulated glenoid cuts and anchor insertion sites. (B) Cross section from 12:00 to 6:00. Note the superior protrusion of the glenoid rim at 12:00 and the continuation with the neck at 6:00. (C) Cross section from 3:00 to 9:00. Note the shelf-like protrusion of the glenoid rim from the glenoid neck at 9:00 and the linear continuation of the rim with the neck at 3:00. (D) Cross section from 4:30 to 10:30. The glenoid bony morphology resembles the cross section morphology of the 3:00 to 9:00 position; however, a slight increase in glenoid rim protrusion was noted at the 10:30 position. (E, F) Cross section at the 1:30 position demonstrated 2 variations: (E) a step-like appearance of the glenoid coracoid junction and (F) a continuous appearance of the glenoid coracoid junction.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
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getmorefigures.php?uid=PMC4555554&req=5

fig1-2325967114556257: (A) Schematic illustration of the glenoid clockface positions: 12:00, superior position; 3:00, anterior position; 6:00, inferior position; 9:00, posterior position. The lines represent the location of the simulated glenoid cuts and anchor insertion sites. (B) Cross section from 12:00 to 6:00. Note the superior protrusion of the glenoid rim at 12:00 and the continuation with the neck at 6:00. (C) Cross section from 3:00 to 9:00. Note the shelf-like protrusion of the glenoid rim from the glenoid neck at 9:00 and the linear continuation of the rim with the neck at 3:00. (D) Cross section from 4:30 to 10:30. The glenoid bony morphology resembles the cross section morphology of the 3:00 to 9:00 position; however, a slight increase in glenoid rim protrusion was noted at the 10:30 position. (E, F) Cross section at the 1:30 position demonstrated 2 variations: (E) a step-like appearance of the glenoid coracoid junction and (F) a continuous appearance of the glenoid coracoid junction.
Mentions: We performed a high-resolution computed tomography scan (0.625-mm axial resolution) of cadaveric shoulders. After 3-dimensional (3D) reconstruction of the scapulae (in MIMICS; Materialise), an evaluation of the glenoid face was performed, and specimens with any abnormality such as dysplasia, fracture, and bone loss due to arthritic changes were excluded. A total of 30 unpaired normal scapulae (16 left, 14 right) were selected for this study. A glenoid face was oriented to that of a clock, with 12:00 denoting the superior position, 3:00 the anterior position, 6:00 the inferior position, and 9:00 the posterior position. A vertical line was drawn on the glenoid face from 12:00 to 6:00 to measure the height of the glenoid. A perpendicular line to the midpoint of the vertical line was generated from 9:00 to 3:00, passing through the center of the glenoid width to define the center of the glenoid. From the center of the glenoid, a 45° angle was generated to define the 1:30, 4:30, 7:30, and 10:30 positions on the glenoid clockface (Figure 1A).

Bottom Line: Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face.The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid.A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.

View Article: PubMed Central - PubMed

Affiliation: Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA.

ABSTRACT

Background: Injuries to the glenoid labrum frequently require repair with anchors. Placing anchor devices arthroscopically can be challenging, and anchor malpositioning can complicate surgical outcomes.

Purpose: To determine the safe insertion range and optimal insertion angle of glenoid labral anchors at various positions on the glenoid rim and to establish surgical guidelines that minimize risk of anchor perforation.

Study design: Descriptive laboratory study.

Methods: Three-dimensional computed tomography scans of 30 normal cadaveric specimens were obtained. A virtual model of a generic labral anchor was inserted into the rim of the glenoid at the clockface positions represented by 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00, and 10:30. At each position, the safe insertion range was the maximal range measured, and the optimal insertion angle was identified as the angle between the bisector of the safe insertion range and the glenoid face.

Results: Progressing in the clockwise direction, beginning at the 12:00 position, the safe insertion ranges (mean ± SD ) were 55.9° ± 10.6°, 63.6° ± 17.6°, 47.7° ± 9.1°, 46.1° ± 8°, 73.9° ± 9.7°, 40.9° ± 6.5°, 40.4° ± 7.4°, and 39.9° ± 7.1°, respectively. The optimal insertion angles were 47.9° ± 7.6°, 53.1° ± 10.9°, 35.0° ± 4.4°, 42.4° ± 4.9°, 60.9° ± 8.4°, 36.6° ± 5.9°, 31.2° ± 4.9°, 34.8° ± 4.6°, respectively.

Conclusion: Optimal insertion angles and safe insertion ranges varied significantly with respect to the position on the glenoid face. The safe insertion range and optimal insertion angle were found to be wider at the anterior glenoid as compared with the posterior glenoid. A posterolateral insertion angle was safer than an anterior insertion angle at the 10:30 position.

Clinical relevance: Proper arthroscopic technique resulting in anchor insertion at the correct angle, depth, and location will prevent anchor-related glenohumeral complications such as glenoid perforation, cartilage damage, persistent pain, decreased range of motion, and failure of the reconstruction.

No MeSH data available.


Related in: MedlinePlus