The relation of the coracoid process to the glenoid: an anatomic study.

PURPOSE: Our purpose was to define the spatial relation of the coracoid process to the glenoid cavity. METHODS: By use of 20 cadaveric shoulders, the location of the tip of the coracoid process was assessed based on the clock face of the glenoid. RESULTS: In all shoulders the tip of the coracoid process was between 1:24 and 2:18 o'clock, with a mean of 1:47 +/- 0:15 o'clock. The distance of the coracoid process tip to the nearest portion of the glenoid labrum was 21.5 +/- 3.6 mm. CONCLUSIONS: Our analysis localizes the coracoid, on average, to the 1:47-o'clock position of the glenoid and 21.5 mm from the nearest portion of the labrum. This anatomic relation may aid the shoulder arthroscopist in locating the coracoid tip during coracoplasty. CLINICAL RELEVANCE: Knowledge of the relation of the coracoid to the glenoid provides the shoulder arthroscopist with essential information regarding the location of the coracoid tip during coracoplasty.

Hill-sachs "remplissage": an arthroscopic solution for the engaging hill-sachs lesion.

We present an arthroscopic technique used to treat traumatic shoulder instability in patients with glenoid bone loss and a large Hill-Sachs lesion. The procedure consists of an arthroscopic capsulotenodesis of the posterior capsule and infraspinatus tendon to fill the Hill-Sachs lesion. With the patient in the lateral decubitus position, a posterior portal is established at the lateral aspect of the convexity of the humeral head that is centered over the lesion. After anterior-inferior and anterior-superior portals have been established, the camera is placed in the anterior-superior portal. The Hill-Sachs lesion is freshened with a bur through the posterior portal. A cannula is inserted in the posterior portal through the deltoid but not through the infraspinatus or capsule, and an anchor is placed in the inferior aspect of the humeral lesion. A penetrating grasper is passed through the tendon and posterior capsule, 1 cm inferior to the initial portal entry site to pull 1 suture limb. A second anchor is placed superiorly, and 1 suture limb is similarly passed. The inferior suture is tied first with the knots remaining extra-articular, pulling the infraspinatus and capsule into the lesion. After completion, the Bankart lesion can then be repaired.

Fourteen-year prospective results of a high-density polyethylene prosthetic anterior cruciate ligament reconstruction.

Our experience with an ultrahigh molecular weight polyethylene (UHMWPE) braided graft indicates that this prosthetic anterior cruciate ligament (ACL) is not associated with the complications of other prosthetic ligaments and has equivalent results compared to an autograft. Nine patients underwent ACL reconstruction with the UHMWPE prosthetic graft, and seven patients received a bone-patellar-bone autograft. Each patient completed a questionnaire regarding their symptoms, a Tegner score, and a Lysholm Score. Objective results included a physical examination and KT1000 measurement. Noninferiority statistical methods were utilized to calculate a power to detect a clinically relevant difference between the groups. Six individuals from the prosthetic group and six of the controls have been followed an average of 14.1 years. In the prosthetic group, one graft failed at 9.5 years after the reconstruction. There were no sterile effusions. There were no graft failures or sterile effusions in the controls. Tegner scores were equivalent (control = 5.5, prosthetic = 5.0) as were the Lysholm scores (control = 82, prosthetic = 80.5). KT1000 testing for the prosthetic group (mean side-to-side difference in maximal displacement = 1.75 mm) was not inferior to the control group (2.0 mm). In this prospective study with 14 years of follow-up, the subjective and objective results of a prosthetic ACL compares favorably to an autograft, suggesting reconsideration of a prosthetic graft options as a viable option.