Authors
Milenin O.N.1, 2, 4, Egiazaryan K.A.3, Rat’ev A.P.3, Gediev T.V.3, 4, Bakulina M.A.4
1 S.I. Spasokukotsky Moscow centre for research and practice in medical rehabilitation, restorative and sports medicine, Moscow
2 Pirogov National Medical and Surgical Center, Moscow
3 Pirogov Russian National Research Medical University, Moscow
4 Laboratory of Orthopedics, Biomechanics and Rehabilitation, Moscow
Abstract
Background: Arthroscopic stabilization of the shoulder joint in anterior labral injuries requires precise positioning of anchor fixation devices. Traditionally, anchors are placed from inferior to superior, starting at the 6 o’clock position on the glenoid. However, in the beach-chair position, access to the inferior pole is limited. There is a knowledge gap in the evaluation of alternative fixation strategies while maintaining biomechanical effectiveness, which is especially important for athletes, given the high risk of anterior shoulder instability and the frequency of relapses after stabilization.
Aims: to optimize and theoretically substantiate the positioning of anchor fixators in the treatment of glenoid labrum injuries in the beach-chair position.
Methods: this study is based on vector modeling analysis of the capsulolabral complex tension under different anchor positions and sequences of fixation. The primary endpoint was the magnitude of the resulting tension force achieved by the fixation.
Results: the analysis showed that initiating fixation at the superior anchor followed by tensioning and attachment to the inferior anchor produces a resulting force comparable in direction and magnitude to the traditional inferior-to-superior fixation. Additionally, fixation of the inferior portion of the capsulolabral complex using two anchors at the 5 and 7 o’clock positions generated a greater force than fixation with a single anchor at the 6 o’clock position.
Conclusions: superior-to-inferior fixation of the capsulolabral complex, as well as fixation of its inferior portion using two anchors at the 5 and 7 o’clock positions, may be considered a biomechanically equivalent alternative to the traditional inferior-to-superior approach (with the inferior anchor at 6 o’clock), particularly when access to the lower glenoid pole is limited, as in the beach-chair position.
Keywords: аnterior shoulder instability, labrum, anchor fixation, vector analysis, beach-chair, arthroscopy, capsulolabral complex.
References
1. Bokshan SS, DeFroda SF, Owens BD. The6 O’Clock Anchor Increases Labral Repair Strength in a Cadaveric Model ofAnterior Shoulder Instability. Arthroscopy. 2019; 35(10): 2795-2800. doi: 10.1016/j.arthro.2019.05.012.
2. Habermeyer P, Lichtenberg S. Arthroscopic repair of anterior instability. In: Craig EV, ed. Master Techniques in Orthopaedic Surgery: The Shoulder. 2nd ed. Lippincott Williams & Wilkins; 2003: 83-101.
3. Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006; 88(8): 1755-1763. doi: 10.2106/JBJS.E.00817.
4. Frank RM, Saccomanno MF, McDonald LS, Moric M, Romeo AA, Provencher MT. Outcomes of arthroscopic anterior shoulder instability in the beach chair versus lateral decubitus position: a systematic review and meta-regression analysis. Arthroscopy. 2014; 30(10): 1349-1365. doi: 10.1016/j.arthro.2014.05.008.
5. Paul RW, Zareef U, Streicher S, et al. Beach-Chair Versus Lateral Decubitus Positioning for Arthroscopic Posterior Shoulder Labral Repair: A Retrospective Comparison of Clinical and Patient-Reported Outcomes. Am J Sports Med. 2022; 50(8): 2211-2218. doi: 10.1177/03635465221095243.
6. Streicher S, Osman A, Zareef U, et al. Poster 182: Beach Chair vs Lateral Decubitus Surgical Positioning for Arthroscopic Anterior Shoulder Stabilization: A Retrospective Comparison of Clinical and Patient-Reported Outcomes. Orthop J Sports Med. 2022; 10(7S5): 2325967121S00743. doi: 10.1177/2325967121S00743.
7. Wilson MR, Field AC, Field LD. Arthroscopic 360° Shoulder Labral Reconstruction: A Stepwise Approach. Arthrosc Tech. 2018; 7(9): e951-e956. doi: 10.1016/j.eats.2018.05.007.
8. Egiazaryan KA, Ratyev AP, Gordienko DI, Grigoriev AV, Ovcharenko NV. Midterm treatment outcomes of proximal humerus fractures by intramedullary fixation. Travmatologiia i ortopediia Rossii. 2018; 24(4): 81–88. (In Russ.)
9. Torrance E, Clarke CJ, Monga P, Funk L, Walton MJ. Recurrence After Arthroscopic Labral Repair for Traumatic Anterior Instability in Adolescent Rugby and Contact Athletes. Am J Sports Med. 2018; 46(12): 2969-2974. doi: 10.1177/0363546518796602.
10. Nakagawa S, Iuchi R, Mae T, et al. Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes. Am J Sports Med. 2017; 45(6): 1406-1414. doi: 10.1177/0363546517694351.
11. Kasik CS, Chang ES, Polster JM, Bicos J. High Rate of Return to Sport in Adolescent Athletes Following Anterior Shoulder Stabilisation: A Systematic Review. JSES Rev Rep Tech. 2019; 3(2): 123-130. doi: 10.1016/j.jses.2019.01.001.
12. Egiazaryan KA, Ratyev AP, Ershov DS, Kuruch EA, Kuznetsov VN, Ovcharenko NV. Surgical treatment of humerus fracture-dislocations: medium-term results. Travmatologiia i ortopediia Rossii. 2020; 26(4): 68–79. (In Russ.)
13. Egiazaryan KA, Lazishvili GD, Ratiev AP, Danilov MA, Otvetchikova DI. Surgical treatment of injuries of the rotator cuff of the shoulder joint. Kafedra travmatologii i ortopedii. 2017; 2(28): 15–18. (In Russ.)
