{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:49:29Z","timestamp":1790412569408,"version":"4.1.0"},"reference-count":18,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2015,3,20]],"date-time":"2015-03-20T00:00:00Z","timestamp":1426809600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bone loss in anterior glenohumeral instability occurs on both the glenoid and the humerus; however, existing biomechanical studies have evaluated glenoid and humeral head defects in isolation. Thus, little is known about the combined effect of these bony lesions in a clinically relevant model on glenohumeral stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis\/Purpose:<\/jats:title>\n                    <jats:p>The purpose of this study was to determine the biomechanical efficacy of a Bankart repair in the setting of bipolar (glenoid and humeral head) bone defects determined via computer-generated 3-dimensional (3D) modeling of 142 patients with recurrent anterior shoulder instability. The null hypothesis was that adding a bipolar bone defect will have no effect on glenohumeral stability after soft tissue Bankart repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A total of 142 consecutive patients with recurrent anterior instability were analyzed with 3D computed tomography scans. Two Hill-Sachs lesions were selected on the basis of volumetric size representing the 25th percentile (0.87 cm\n                      <jats:sup>3<\/jats:sup>\n                      ; small) and 50th percentile (1.47 cm\n                      <jats:sup>3<\/jats:sup>\n                      ; medium) and printed in plastic resin with a 3D printer. A total of 21 cadaveric shoulders were evaluated on a custom shoulder-testing device permitting 6 degrees of freedom, and the force required to translate the humeral head anteriorly 10 mm at a rate of 2.0 mm\/s with a compressive load of 50 N was determined at 60\u00b0 of glenohumeral abduction and 60\u00b0 of external rotation. All Bankart lesions were made sharply from the 2- to 6-o\u2019clock positions for a right shoulder. Subsequent Bankart repair with transosseous tunnels using high-strength suture was performed. Hill-Sachs lesions were made in the cadaver utilizing a plastic mold from the exact replica off the 3D printer. Testing was conducted in the following sequence for each specimen: (1) intact, (2) posterior capsulotomy, (3) Bankart lesion, (4) Bankart repair, (5) Bankart lesion with 2-mm glenoid defect, (6) Bankart repair, (7) Bankart lesion with 2-mm glenoid defect and Hill-Sachs lesion, (8) Bankart repair, (9) Bankart lesion with 4-mm glenoid defect and Hill-Sachs lesion, (10) Bankart repair, (11) Bankart lesion with 6-mm glenoid defect and Hill-Sachs lesion, and (12) Bankart repair. All sequences were used first for a medium Hill-Sachs lesion (10 specimens) and then repeated for a small Hill-Sachs lesion (11 specimens). Three trials were performed in each condition, and the mean value was used for data analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A statistically significant and progressive reduction in load to translation was observed after a Bankart lesion was created and with the addition of progressive glenoid defects for each humeral head defect. For medium (50th percentile) Hill-Sachs lesions, there was a 22%, 43%, and 58% reduction in stability with a 2-, 4-, and 6-mm glenoid defect, respectively. For small (25th percentile) Hill-Sachs lesions, there was an 18%, 27%, and 42% reduction in stability with a 2-, 4-, and 6-mm glenoid defect, respectively. With a \u22652-mm glenoid defect, the medium Hill-Sachs group demonstrated significant reduction in translation force after Bankart repair ( P &lt; .01), and for the small Hill-Sachs group, a \u22654-mm glenoid defect was required to produce a statistical decrease ( P &lt; .01) in reduction force after repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Combined glenoid and humeral head defects have an additive and negative effect on glenohumeral stability. As little as a 2-mm glenoid defect with a medium-sized Hill-Sachs lesion demonstrated a compromise in soft tissue Bankart repair, while small-sized Hill-Sachs lesions showed compromise of soft tissue repair with \u22654-mm glenoid bone loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Bipolar bony lesions of the glenoid and humeral head occur frequently together in clinical practice. Surgeons should be aware that the combined defects and glenoid bone loss of 2 to 4 mm or approximately 8% to 15% of the glenoid could compromise Bankart repair and thus may require surgical strategies in addition to traditional Bankart repair alone to optimize stability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546515574677","type":"journal-article","created":{"date-parts":[[2015,3,21]],"date-time":"2015-03-21T00:20:01Z","timestamp":1426897201000},"page":"1422-1429","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":155,"title":["The Effect of a Combined Glenoid and Hill-Sachs Defect on Glenohumeral Stability"],"prefix":"10.1177","volume":"43","author":[{"given":"Robert A.","family":"Arciero","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Parrino","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Bernhardson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Naval Medical Center, San Diego, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vilmaris","family":"Diaz-Doran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elifho","family":"Obopilwe","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P.","family":"Cote","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr","family":"Golijanin","sequence":"additional","affiliation":[{"name":"Sports Medicine Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustus D.","family":"Mazzocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew T.","family":"Provencher","sequence":"additional","affiliation":[{"name":"Sports Medicine Division, Department of Orthopaedic Surgery, Massachusetts General Hospital, 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2015,3,20]]},"reference":[{"key":"bibr1-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.89B11.18962"},{"key":"bibr2-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1053\/jars.2000.17715"},{"key":"bibr3-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1016\/0749-8063(89)90138-2"},{"key":"bibr4-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2013.10.004"},{"key":"bibr5-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-8063(03)00684-4"},{"key":"bibr6-0363546515574677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200001000-00005"},{"key":"bibr7-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509350295"},{"key":"bibr8-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503262188"},{"key":"bibr9-0363546515574677","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200908000-00002"},{"key":"bibr10-0363546515574677","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00906"},{"key":"bibr11-0363546515574677","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-20-04-242"},{"key":"bibr12-0363546515574677","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198163060-00001"},{"key":"bibr13-0363546515574677","doi-asserted-by":"publisher","DOI":"10.1177\/0363546504271521"},{"issue":"3","key":"bibr14-0363546515574677","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1177\/036354659702500306","volume":"25","author":"Sekiya 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Patients"],"short-title":[],"issued":{"date-parts":[[2015,3,20]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2015,6]]}},"alternative-id":["10.1177\/0363546515574677"],"URL":"https:\/\/doi.org\/10.1177\/0363546515574677","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,3,20]]}}}