Determining optimal length of coracoid graft in the modified Bristow procedure for anterior shoulder instability: A three-dimensional finite element analysis

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.