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Knee Surgery, Sports Traumatology, Arthroscopy

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01-02-2016 | Shoulder

Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability

Authors: Jeffrey F. Sodl, Michelle H. McGarry, Sean T. Campbell, James E. Tibone, Thay Q. Lee

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2016

Abstract

Purpose

The purpose of this study was to determine the effect of a stepwise arthroscopic anterior plication and arthroscopic-equivalent rotator interval (RI) closure on glenohumeral range of motion, kinematics, and translation in the setting of anterior instability.

Methods

Six cadaveric shoulders were stretched to 10 % beyond maximum external rotation (ER) to create an anterior shoulder instability model. Range of motion, kinematics, and glenohumeral translations were recorded for the following conditions: (1) intact, (2) stretched, (3) after anterior capsular plication, and (4) after RI closure.

Results

The total range of motion after capsular stretching increased significantly in the 60° abduction position (p = 0.037). Average ER and total rotation were significantly decreased from the intact and stretched conditions by both repair conditions at 60° and 0° of glenohumeral abduction (p < 0.05), with no significant difference between plication and additional RI closure. At 0° abduction and 0° ER, glenohumeral translation decreased significantly from the stretched condition after RI closure with 10 and 15 N anterior and 10 N posterior loads (p < 0.05). At 30° ER, translation after RI closure was significantly less than both the intact and stretched conditions with 10 N anterior loads (p = 0.009; p = 0.004). These changes in translational stability were not seen with plication alone.

Conclusions

Anterior capsular plication reduced glenohumeral range of motion back to the intact state, and often tighter. RI closure did not contribute significantly to the reduction in the range of motion, but had implications regarding glenohumeral translation. Caution should be taken when performing anterior plication and combined repairs to avoid overtightening. Intraoperative translations could be useful when debating RI closure in patients with unidirectional anterior glenohumeral instability.

Ando A, Sugaya H, Takahashi N, Kawai N, Hagiwara Y, Itoi E (2012) Arthroscopic management of selective loss of external rotation after surgical stabilization of traumatic anterior glenohumeral instability: arthroscopic restoration of anterior transverse sliding procedure. Arthroscopy 28(6):749–753CrossRefPubMed

Borsa PA, Laudner KG, Sauers EL (2008) Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med 38(1):17–36CrossRefPubMed

Brophy RH, Marx RG (2009) The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 25(3):298–304CrossRefPubMed

Cole BJ, Romeo AA (2001) Arthroscopic shoulder stabilization with suture anchors: technique, technology, and pitfalls. Clin Orthop Relat Res 390:17–30CrossRefPubMed

D’Alessandro DF, Bradley JP, Fleischli JE, Connor PM (2004) Prospective evaluation of thermal capsulorrhaphy for shoulder instability. Am J Sports Med 32(1):21–33CrossRefPubMed

Dumont GD, Russell RD, Robertson WJ (2011) Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment. Curr Rev Musculoskelet Med 4(4):200–207PubMedCentralCrossRefPubMed

Farber AJ, ElAttrache NS, Tibone JE, McGarry MH, Lee TQ (2009) Biomechanical analysis comparing a traditional superior-inferior arthroscopic rotator interval closure with a novel medial-lateral technique in a cadaveric multidirectional instability model. Am J Sports Med 37(6):1178–1185CrossRefPubMed

Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL (1995) Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 23(5):557–563CrossRefPubMed

Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF (1995) Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 23(2):233–239CrossRefPubMed

10.

Gillis RC, Donaldson CT, Kim H, Love JM, Dreese JC (2012) Arthroscopic suture anchor capsulorrhaphy versus labral-based suture capsulorrhaphy in a cadaveric model. Arthroscopy 28(11):1615–1621CrossRefPubMed

11.

Good CR, Shindle MK, Kelly BT, Wanich T, Warren RF (2007) Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy 23(7):797.e791–797.e795CrossRef

12.

Handoll H, Almaiyah M, Rangan A (2004) Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev 1:CD004325PubMed

13.

Jones KJ, Kahlenberg CA, Dodson CC, Nam D, Williams RJ, Altchek DW (2012) Arthroscopic capsular plication for microtraumatic anterior shoulder instability in overhead athletes. Am J Sports Med 40(9):2009–2014CrossRefPubMed

14.

Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9(4):336–341CrossRefPubMed

15.

Karas SG (2002) Arthroscopic rotator interval repair and anterior portal closure. Arthroscopy 18(4):436–439CrossRefPubMed

16.

Kvitne RS, Jobe FW (1993) The diagnosis and treatment of anterior instability in the throwing athlete. Clin Orthop Relat Res 291:107–123PubMed

17.

Laudner K, Meister K, Noel B, Deter T (2012) Anterior glenohumeral laxity is associated with posterior shoulder tightness among professional baseball pitchers. Am J Sports Med 40(5):1133–1137CrossRefPubMed

18.

Lee HJ, Kim NR, Moon SG, Ko SM, Park JY (2012) Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol 42(2):231–238CrossRefPubMed

19.

Luke TA, Rovner AD, Karas SG, Hawkins RJ, Plancher KD (2004) Volumetric change in the shoulder capsule after open inferior capsular shift versus arthroscopic thermal capsular shrinkage: a cadaveric model. J Shoulder Elbow Surg 13(2):146–149CrossRefPubMed

20.

Mihata T, Gates J, McGarry MH, Neo M, Lee TQ (2013) Effect of posterior shoulder tightness on internal impingement in a cadaveric model of throwing. Knee Surg Sport Traumatol Arthrosc. doi:10.1007/s00167-013-2381-7

21.

Mihata T, Lee Y, McGarry MH, Abe M, Lee TQ (2004) Excessive humeral external rotation results in increased shoulder laxity. Am J Sports Med 32(5):1278–1285CrossRefPubMed

22.

Mologne TS, Zhao K, Hongo M, Romeo AA, An KN, Provencher MT (2008) The addition of rotator interval closure after arthroscopic repair of either anterior or posterior shoulder instability: effect on glenohumeral translation and range of motion. Am J Sports Med 36(6):1123–1131CrossRefPubMed

23.

Moon YL, Singh H, Yang H, Chul LK (2011) Arthroscopic rotator interval closure by purse string suture for symptomatic inferior shoulder instability. Orthopedics 34:4

24.

Owens BD, Dawson L, Burks R, Cameron KL (2009) Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am 91(4):791–796CrossRefPubMed

25.

Paulson MM, Watnik NF, Dines DM (2000) Coracoid impingement syndrome, rotator interval reconstruction, and biceps tenodesis in the overhead athlete. Oper Tech Sport Med 8(4):268–275CrossRef

26.

Peltier KE, McGarry MH, Tibone JE, Lee TQ (2012) Effects of combined anterior and posterior plication of the glenohumeral ligament complex for the repair of anterior glenohumeral instability: a biomechanical study. J Shoulder Elbow Surg 21(7):902–909CrossRefPubMed

27.

Pope EJ, Ward JP, Rokito AS (2011) Anterior shoulder instability: a history of arthroscopic treatment. Bull NYU Hosp Jt Dis 69(1):44–49PubMed

28.

Provencher MT, Mologne TS, Hongo M, Zhao K, Tasto JP, An K-N (2007) Arthroscopic versus open rotator interval closure: biomechanical evaluation of stability and motion. Arthroscopy 23(6):583–592CrossRefPubMed

29.

Reinold MM, Gill TJ (2010) Current concepts in the evaluation and treatment of the shoulder in overhead-throwing athletes, part 1: physical characteristics and clinical examination. Sports Health 2(1):39–50PubMedCentralCrossRefPubMed

30.

Reinold MM, Gill TJ, Wilk KE, Andrews JR (2010) Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. Sports Health 2(2):101–115PubMedCentralCrossRefPubMed

31.

Remia LF, Ravalin RV, Lemly KS, McGarry MH, Kvitne RS, Lee TQ (2003) Biomechanical evaluation of multidirectional glenohumeral instability and repair. Clin Orthop Relat Res 416:225–236CrossRefPubMed

32.

Shafer BL, Mihata T, McGarry MH, Tibone JE, Lee TQ (2008) Effects of capsular plication and rotator interval closure in simulated multidirectional shoulder instability. J Bone Joint Surg Am 90(1):136–144CrossRefPubMed

33.

te Slaa RL, Wijffels MP, Brand R, Marti RK (2004) The prognosis following acute primary glenohumeral dislocation. J Bone Joint Surg Br 86(1):58–64

34.

Thomas SJ, Swanik CB, Swanik K, Kelly JD (2013) Change in glenohumeral rotation and scapular position after a division I collegiate baseball season. J Sport Rehabil 22(2):115–121PubMed

35.

Thomas SJ, Swanik KA, Swanik C, Huxel KC, Kelly JD (2010) Change in glenohumeral rotation and scapular position after competitive high school baseball. J Sport Rehabil 19(2):125PubMed

36.

Tibone JE, McMahon PJ, Shrader TA, Sandusky MD, Lee TQ (1998) Glenohumeral joint translation after arthroscopic, nonablative, thermal capsuloplasty with a laser. Am J Sports Med 26(4):495–498PubMed

37.

Treacy SH, Field LD, Savoie FH (1997) Rotator interval capsule closure: an arthroscopic technique. Arthroscopy 13(1):103–106CrossRefPubMed

38.

Wichman MT, Snyder SJ (1997) Arthroscopic capsular plication for multidirectional instability of the shoulder. Oper Tech Sports Med 5(4):238–243CrossRef

39.

Wolf EM, Eakin CL (1998) Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy 14(2):153–163CrossRefPubMed

Title: Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability
Authors: Jeffrey F. Sodl
Michelle H. McGarry
Sean T. Campbell
James E. Tibone
Thay Q. Lee
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-014-2878-8

At a glance: The STEP trials

Springer Medicine

Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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