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Determining optimal length of coracoid graft in the modified Bristow procedure for anterior shoulder instability: A
Hirotaka Sano1, Tatsuro Komatsuda2, Kazuhide Suzuki3
1Division of Orthopedics, Sendai City Hospital, Sendai, Japan.
Background:
There is a lack of consensus concerning the coracoid graft length in the modified Bristow procedure.
Objective:
We attempted to determine the optimal graft length using the three-dimensional finite element method.
Methods:
In a shoulder model with a 25% anterior glenoid defect, a coracoid graft of varying lengths (5, 10, 15, and 20 mm) was fixed using a half-threaded screw. First, a compressive load of 500 N was applied to the screw head to determine the graft failure load during screw tightening. Next, a tensile load (200 N) was applied to the graft to determine the failure load due to biceps muscle traction.
Results:
In the screw compression, the failure loads in the 5-, 10-, 15-, and 20-mm models were 252, 370, 377, and 331 N, respectively. In the tensile load applied to the coracoid graft, the failure load exceeded 200 N for both the 5- and 10-mm models.
Conclusion:
The 5-mm graft had a high risk of fracture during intraoperative screw tightening. As for the biceps muscle traction, the 5- and 10-mm-grafts had a lower failure risk than the 15- and 20-mm-grafts. Therefore, we believe that the optimal length of the coracoid graft is 10 mm in the modified Bristow procedure.