In this thesis we performed an anatomical evaluation of one of the major passive constraints for shoulder instability, being the labrum and its phylogenetic counterpart at the hip joint. An... Show moreIn this thesis we performed an anatomical evaluation of one of the major passive constraints for shoulder instability, being the labrum and its phylogenetic counterpart at the hip joint. An evaluation of patient outcome measurement scores including a discussion on the Oxford Shoulder Score and the Oxford Shoulder Instability Score has been made (Appendix Chapter 3). An evaluation of management of acute first-time anterior shoulder dislocations in the Netherlands by means of a shoulder questionnaire (including treatment of recurrent shoulder instability) is being presented. A detailed clinical and radiological evaluation of the mid- and long term results after a labrum joint capsule (open Bankart) repair is given. And finally, we evaluated a novel technique addressing bony defects of the glenoid. Show less
Willemsen, K.; Berendes, T.D.; Geurkink, T.; Bleys, R.L.A.W.; Leeflang, M.A.; Weinans, H.; ... ; Wal, B.C.H. van der 2019
Background: Anterior glenohumeral instability with >20% glenoid bone loss is a disorder that can be treated with the Latarjet stabilizing procedure; however, complications are common. The... Show moreBackground: Anterior glenohumeral instability with >20% glenoid bone loss is a disorder that can be treated with the Latarjet stabilizing procedure; however, complications are common. The purposes of this study were to (1) evaluate the effect of an anatomic-specific titanium implant produced by 3-dimensional (3D) printing as a treatment option for recurrent shoulder instability with substantial glenoid bone loss and (2) compare the use of that implant with the Latarjet procedure.Methods: Ten fresh-frozen cadaveric shoulders (mean age at the time of death, 78 years) were tested in a biomechanical setup with the humerus in 30 degrees of abduction and in neutral rotation. The shoulders were tested under 5 different conditions: (1) normal situation, (2) creation of an anterior glenoid defect, (3) implantation of an anatomic-specific titanium implant produced by 3D printing, and the Latarjet procedure (4) with and (5) without 10 N of load attached to the conjoined tendon. In each condition, the humerus was translated 10 mm anteriorly relative to the glenoid, and the maximum peak translational force that was necessary for this translation was measured.Results: After creation of the glenoid defect, the mean translational peak force decreased by 30% +/- 6% compared with that for the normal shoulder. After restoration of the original glenoid anatomy, the translational force needed to dislocate the humeral head from the glenoid significantly increased compared with that in the defect condition-to 119% +/- 16% of normal (p < 0.01) with the 3D-printed anatomic-specific implant and to 121% +/- 48% of normal (p < 0.01) following the Latarjet procedure. No significant differences in mean translational force were found between the anatomic-specific implant and the Latarjet procedure (p = 0.72).Conclusions: The mean translational peak force needed to dislocate the humerus 10 mm anteriorly on the glenoid was higher after glenoid restoration with the 3D-printed anatomic-specific implant compared with when the glenoid had a 20% surface defect but also compared with when the glenoid was intact. No differences in mean translational peak force were found between the 3D-printed anatomic-specific glenoid implant and the Latarjet procedure, although there was less variability in the 3D-implant condition. Show less
