Editorial Commentary: Buttoning Up After Recurrent Anterior Shoulder Instability: The Eden-Hybinette Procedure Is an Effective Salvage After Failed Latarjet

Operative management of anterior glenohumeral dislocation can confer significant improvements in subjective shoulder function, pain, and overall stability. Although the coracoid-based Latarjet procedure has long been considered the ultimate treatment for complex anterior shoulder instability with glenoid or bipolar bone loss, few authors have considered the unimaginable question: what do you do when a patient fails Latarjet? A modified arthroscopic technique of the Eden-Hybinette procedure allows for revision anterior glenoid augmentation of critical glenoid bone loss with autologous tricortical iliac crest, while suture button fixation may obviate hardware complications previously seen with bicortical screw fixation. Although distal tibial allograft provides excellent congruity, viable articular cartilage, and no harvest site morbidity, financial costs and graft availability must also be considered. With favorable patient-reported outcomes, excellent rates of radiographic union, and reliable return to sport, the Eden-Hybinette procedure with suture button-based construct offers a viable alternative for patients with advanced glenoid bone loss (>20%) or revision scenarios.     

髋臼前倾和后倾的影像学及生物力学研究

目的探讨髋臼前、后倾的影像学特点和在前、后倾时髋臼缘的生物力学特点,为临床治疗提供相关的依据。方法应用成年防腐骨盆标本制作4例发生髋臼前倾及后倾的骨盆模型,拍模型的标准骨盆正位片,模型加载,分别对前倾组及后倾组进行生物力学测定和影像学观察。结果标准骨盆正位片上前倾时出现“人”字形,后倾时出现交叉征及后壁征。前倾组各点应变值正常时与前倾时经秩和检验,P〈0．05,差异有统计学意义;后倾组各点应变值正常时与前倾时经秩和检验P〈0．05,差异有统计学意义。结论本实验对髋臼前、后倾髋臼缘力学测定,可以推测髋臼前、后倾与许多髋关节退行性疾病有密切联系。通过影像学特点早期发现、早期治疗,并根据生物力学特点制定适当的方案,可提高临床治疗效果。     

Microcomputed tomography assessment of glenoid component cementation techniques in total shoulder arthroplasty

Various strategies have been described to improve glenoid component cementation technique in shoulder arthroplasty, such as the “weephole” technique (WH), which is thought to allow for improved cement mantles by suction venting the glenoid vault through the coracoid. The purpose of this study was to compare the cement mantle created using standard syringe pressurization (SP) to WH or a new, modified weephole technique (MWH), not requiring specific instrumentation of the coracoid medullary canal. Fourteen cadaveric scapulae underwent preparation of the glenoid to allow for implantation of glenoid components. Component fixation was achieved using SP, WH, or MWH. The volumes of cement surrounding each individual peg on the component, of the cement mantle between the back of the glenoid, and of the reamed glenoid face were quantified using micro‐CT. Compared to SP, significantly larger cement mantles were observed around all pegs with both the WH (p = 0.023) and MWH (p = 0.007). Similarly, both the WH and MWH techniques demonstrated significantly decreased cement behind the glenoid component (p = 0.003) compared to SP, with no significant difference between the WH and the MWH techniques. Both WH and MWH techniques increase cement mantle volume around individual pegs and decrease the amount of glenoid face cement compared to conventional SP. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:559–564, 2010