Research Papers

Anchor Hole Placement for Bankart Repairs and Its Interaction With Variable Size Hill–Sachs Defects-Minimizing Risk of Glenoid Rim Fractures

[+] Author and Article Information
Danè Dabirrahmani

Faculty of Medicine and Health Sciences,
Macquarie University,
Sydney, NSW 2109, Australia
e-mail: Daneh.Turner@mq.edu.au

Desmond Bokor, Richard Appleyard

Faculty of Medicine and Health Sciences,
Macquarie University,
Sydney, NSW 2109, Australia

Thomas Tarento

Faculty of Medicine and Health Sciences,
Macquarie University,
Sydney, NSW 2109, Australia;
School of Aerospace,
Mechanical and Mechatronic Engineering,
The University of Sydney,
Sydney, NSW 2006, Australia

Shahrulazua Ahmad

Sports Injury Unit,
Department of Orthopaedic and Traumatology,
Universiti Kebangsaan Malaysia Medical Centre,
Kuala Lumpur, Malaysia

1Corresponding author.

Manuscript received March 8, 2018; final manuscript received June 6, 2019; published online July 11, 2019. Assoc. Editor: Steven D. Abramowitch.

J Biomech Eng 141(10), 101003 (Jul 11, 2019) (6 pages) Paper No: BIO-18-1127; doi: 10.1115/1.4043969 History: Received March 08, 2018; Revised June 06, 2019

As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability after Bankart lesions of the shoulder, increases, an emerging problem has been the incidence of glenoid rim fractures through suture drill holes. Very little is known regarding the effect of the Hill–Sachs lesion on the glenoid's susceptibility to fracture and how drill hole location can further affect this. This study used finite element modeling techniques to investigate the risk of fracture of the glenoid rim in relation to variable sized Hill–Sachs defects impacting on the anterior glenoid edge with suture anchor holes placed in varying positions. The distribution of Von Mises (VM) stresses and the factor of safety (FOS) for each of the configurations were calculated. The greatest peak in VM stresses was generated when the glenoid was loaded with a small Hill–Sachs lesion. The VM stresses were lessened and the FOS increased (reducing likelihood of failure) with increasing size of the Hill–Sachs lesion. Placement of the suture drill holes at 2 mm from the glenoid rim showed the highest risk of failure; and when combined with a medium sized Hill–Sachs lesion, which matched the central line of the drill holes, a potentially clinically significant configuration was presented. The results of this study are useful in assisting the surgeon in understanding the interaction between the Hill–Sachs lesion size and the placement of suture anchors with the purpose of minimizing the risk of subsequent rim fracture with new injury.

Copyright © 2019 by ASME
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Fig. 1

Arthroscopic images indicating proposed anchor drill holes at 2.00, 3.30, and 5.00 o'clock positions

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Fig. 2

Representative images of the inclination and positioning of one set of suture anchor holes (2 mm offset model), right cross-sectional image showing anchor hole inclinations

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Fig. 3

Three different load configurations (left to right): case 1, 0 mm offset and small load area (small area = 5.86% of the glenoid face); case 5, 2 mm offset and medium load area (medium area = 12.55% of glenoid face); and case 9, 4 mm offset and large load area (large area = 19.84% of glenoid face) offset from glenoid rim. In each case, the Hill–Sachs load area is overlapping halfway across the glenoid anchor drill holes.

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Fig. 4

Analyzed regions of interest for VM stress and FOS calculations for the 2 mm offset model

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Fig. 5

Average VM stresses of the regions of interest for each of the nine models, showing three different offsets and three different Hill–Sachs area of loading sizes

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Fig. 6

Average FOS for three regions of interest for nine configurations from 1 to 8 times body weight. As the Hill–Sachs load increases, so does the likelihood of fracture.

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Fig. 7

Average FOS at 8xBW for three different load cases (small, medium and large Hill–Sachs loaded area) and three different offset values (0 mm, 2 mm, and 4 mm). The dashed line indicates the failure threshold.

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Fig. 8

FOS at 8xBW of ROI-1 for all nine operative cases and nine intact cases

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Fig. 9

FOS at 8xBW of ROI-2 for all nine operative cases and nine intact cases

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Fig. 10

FOS at 8xBW of ROI-3 for all nine operative cases and intact cases

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Fig. 11

CT arthrogram showing “postage-stamp” glenoid rim fracture through glenoid suture anchor holes



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