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Complex Shoulder Instability: the Role of the Latarjet Coracoid Transfer

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Complex Shoulder Instability: the Role of the Latarjet Coracoid Transfer Western University Scholarship@Western Electronic Thesis and Dissertation Repository 8-20-2013 12:00 AM Complex Shoulder Instability: The Role of the Latarjet Coracoid Transfer Ryan Degen The University of Western Ontario Supervisor Dr. Jim Johnson The University of Western Ontario Joint Supervisor Dr. George Athwal The University of Western Ontario Graduate Program in Medical Biophysics A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Science © Ryan Degen 2013 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Orthopedics Commons, and the Surgical Procedures, Operative Commons Recommended Citation Degen, Ryan, "Complex Shoulder Instability: The Role of the Latarjet Coracoid Transfer" (2013). Electronic Thesis and Dissertation Repository. 1454. https://ir.lib.uwo.ca/etd/1454 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. COMPLEX SHOULDER INSTABILITY: THE ROLE OF THE LATARJET CORACOID TRANSFER Integrated Article Format by Ryan Michael Degen Graduate Program in Medical Biophysics A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Ryan Michael Degen 2013 Abstract Recurrent anterior shoulder instability is a common clinical entity that is debilitating for patients, and often requires surgical stabilization. Recurrence rates following soft-tissue stabilization procedures are moderately high and have been attributed to associated bony defects of either the glenoid or humeral head. Complex shoulder instability, which is defined as instability associated with bony defects around the shoulder, is a challenging clinical problem. The Latarjet coracoid transfer has been proposed as a treatment option and its resultant stabilizing effects have been explored in this biomechanical cadaver-based study and compared to alternative procedures. For both glenoid and humeral head defects, the Latarjet coracoid transfer adequately stabilized the shoulder, outperforming other procedures often clinically utilized for these scenarios. It did, however, result in increased superior translation of the shoulder compared to other procedures, the clinical significance of which is presently unknown. The Latarjet coracoid transfer is a useful procedure for complex shoulder instability. Further study should assess for any potential deleterious clinical effects following this procedure. Keywords Shoulder, Biomechanics, Recurrent instability, Latarjet coracoid transfer ii Co-Authorship Statement Chapter 1 Ryan Degen – Sole Author Chapter 2 Ryan Degen – Study Design, Specimen Preparation, Data Collection, Manuscript Review Josh Giles – Study Design, Specimen Preparation, Data Collection, Data Analysis, Manuscript Preparation Jim Johnson – Study Design, Manuscript Review George Athwal – Study Design, Specimen Preparation, Manuscript Review Chapter 3 Ryan Degen – Study Design, Specimen Preparation, Data Collection, Data Analysis, Manuscript Preparation Josh Giles – Study Design, Specimen Preparation, Data Collection, Data Analysis, Manuscript Review Jim Johnson – Study Design, Manuscript Review George Athwal – Study Design, Specimen Preparation, Manuscript Review Chapter 4 Ryan Degen – Data Collection, Data Analysis, Manuscript Preparation Josh Giles – Study Design, Specimen Preparation, Data Collection, Data Analysis, Manuscript Review Harm Boons – Study Design, Specimen Preparation, Manuscript Review Jim Johnson – Study Design, Manuscript Review George Athwal – Study Design, Specimen Preparation, Manuscript Review Chapter 5 Ryan Degen – Sole Author iii Publication Status Chapter 2 A version of this manuscript has been submitted for publication in the Journal of Bone and Joint Surgery, American Volume and is awaiting review. Chapter 3 A version of this manuscript has been submitted for publication in Clinical Orthopaedics and Related Research and is awaiting review. Chapter 4 A version of this manuscript has been accepted for publication in the International Journal of Shoulder Surgery. Permission to reprint this version of the manuscript has been granted by the Publisher. iv Acknowledgments I would like to thank a few people who were instrumental in the completion of this thesis. None of this work would have been possible without my supervisors Dr. George Athwal and Dr. Jim Johnson, as well as my co-investigator Josh Giles. I would like to thank all of you for your efforts in completing this research. Dr. Athwal and Johnson – I appreciate your help not only organizing and overseeing this research, but in helping prepare me for a career in orthopedic research. From advisory committee meetings, to rehearsal presentations, and constructive criticisms on manuscript preparation, the advice and assistance you have both provided will go a long way towards helping me start my own academic research practice. Josh – thank you for your tremendous contributions to this work. The simulator that you have designed and continually improved on, your mastery of any and all software programs for data collection and analysis and your patience during our marathon testing sessions were all very much appreciated. I have no doubt that your future is bright and wish you well in all future endeavours. To Dr. King, Dr. Canham and Dr. Johnson – thank you for your attentiveness and feedback during our communication course sessions. These sessions have certainly improved my understanding of some fundamental principles in biomechanical research, but have undoubtedly improved my personal communication and presentation skills. All presentations I have given since these sessions have been met with praise and I attribute this largely to your advice, so thank you. I would also like to thank the Department of Medical Biophysics for being understanding of the challenges faced with being a graduate student and medical resident, particularly for being accommodating with course selections and alternate low-level comprehensive examinations. Lastly, I would like to thank my wife, Lindsay. Thank you for being so helpful and patient with me while I took on yet another task that added stress to our lives and ate away at weekends and vacations over the past two years. This master’s degree will be an integral part of my career, and our life, moving forward and I wouldn’t have been able to complete it without your love and support. v Table of Contents Abstract............................................................................................................................... ii Co-Authorship Statement...................................................................................................iii Acknowledgments............................................................................................................... v Table of Contents............................................................................................................... vi List of Tables ...................................................................................................................... x List of Figures.................................................................................................................... xi Chapter 1............................................................................................................................. 1 1 Introduction.................................................................................................................... 1 1.1 The Shoulder........................................................................................................... 1 1.1.1 Osteology.................................................................................................... 1 Labrum, Capsule and Ligaments ............................................................................ 7 1.2 Shoulder Kinematics............................................................................................. 14 1.2.1 Static Stabilizers........................................................................................ 14 1.2.2 Dynamic Stabilizers.................................................................................. 16 1.3 Shoulder Instability............................................................................................... 20 1.3.1 Pathophysiology........................................................................................ 20 1.4 Treatment Options ................................................................................................ 28 1.5 Study Rationale..................................................................................................... 39 1.6 Objectives ............................................................................................................. 40 1.7 Hypotheses............................................................................................................ 40 1.8 Thesis Overview ................................................................................................... 41 1.9 References............................................................................................................. 42 Chapter 2..........................................................................................................................
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