scholarly journals Mapping of the Inferior Glenohumeral Ligament for Suture Pullout Strength: A Biomechanical Analysis

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096964
Author(s):  
Sumit Raniga ◽  
Joseph Cadman ◽  
Danè Dabirrahmani ◽  
David Bui ◽  
Richard Appleyard ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Biomechanical Study ◽  
Labral Repair ◽  
Pullout Strength ◽  
Recurrent Instability ◽  
Glenohumeral Ligament ◽  
Time Zero ◽  
Capsular Plication ◽  
Inferior Glenohumeral Ligament ◽  
The Impact

Background: Suture pullout during rehabilitation may result in loss of tension in the inferior glenohumeral ligament (IGHL) and contribute to recurrent instability after capsular plication, performed with or without labral repair. To date, the suture pullout strength in the IGHL is not well-documented. This may contribute to recurrent instability. Purpose/Hypothesis: A cadaveric biomechanical study was designed to investigate the suture pullout strength of sutures in the IGHL. We hypothesized that there would be no significant variability of suture pullout strength between specimens and zones. Additionally, we sought to determine the impact of early mobilization on sutures in the IGHL at time zero. We hypothesized that capsular plication sutures would fail under low load. Study Design: Descriptive laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were dissected to isolate the IGHL complex, which was then divided into 18 zones. Sutures in these zones were attached to a linear actuator, and the resistance to suture pullout was recorded. A suture pullout strength map of the IGHL was constructed. These loads were used to calculate the load applied at the hand that would initiate suture pullout in the IGHL. Results: Mean suture pullout strength for all specimens was 61.6 ± 26.1 N. The maximum load found to cause suture pullout through tissue was found to be low, regardless of zone of the IGHL. Calculations suggest that an external rotation force applied to the hand of only 9.6 N may be sufficient to tear capsular sutures at time zero. Conclusion: This study did not provide clear evidence of desirable locations for fixation in the IGHL. However, given the low magnitude of failure loads, the results suggest the timetable for initiation of range-of-motion exercises should be reconsidered to prevent suture pullout through the IGHL. Clinical Relevance: From this biomechanical study, the magnitude of force required to cause suture pullout through the IGHL is met or surpassed by normal postoperative early range-of-motion protocols.

Mechanical Properties of the Glenohumeral Capsule Change With Simulated Injury

2010 ◽  
Author(s):  
Carrie A. Voycheck ◽  
Patrick J. McMahon ◽  
Richard E. Debski
Keyword(s):  
Glenohumeral Joint ◽  
Tissue Sample ◽  
Biomechanical Properties ◽  
Recurrent Instability ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament ◽  
Normal Stability ◽  
Glenohumeral Capsule ◽  
Anterior Direction ◽  
Repair Techniques

The glenohumeral joint suffers more dislocations than any other joint, most of which occur in the anterior direction. The anterior band of the inferior glenohumeral ligament (AB-IGHL) is the primary restraint to these dislocations and as a result experiences the highest strains during these events. [1] Injuries to the capsule following dislocation include permanent tissue deformation that increases joint mobility and contributes to recurrent instability. [2] This deformation can be quantified by measuring nonrecoverable strain. [3] Simulated injury of the capsule results in permanently elongated tissue and nonrecoverable strain. Current surgical repair techniques are subjective and may not fully address all capsular tissue pathologies resulting from dislocation. Surgeons typically repair the injured capsule by plicating the stretched-out tissue; however, these techniques are inadequate with 23% of patients needing an additional repair. [4] Quantitative data on the changes in the biomechanical properties of the capsule following dislocation may help to predict the amount of capsular tissue to plicate for restoring normal stability. Therefore, the objectives of this study were to quantify changes in stiffness and material properties of the AB-IGHL tissue sample following simulated injury (creation of nonrecoverable strain).

Development of a Finite Element Model of the Inferior Glenohumeral Ligament of the Glenohumeral Joint

2003 ◽  
Author(s):  
William J. Newman ◽  
Richard E. Debski ◽  
Susan M. Moore ◽  
Jeffrey A. Weiss
Keyword(s):  
Finite Element ◽  
Glenohumeral Joint ◽  
External Rotation ◽  
Element Model ◽  
Fe Modeling ◽  
Glenohumeral Ligament ◽  
Subject Specific ◽  
Inferior Glenohumeral Ligament ◽  
Glenohumeral Capsule ◽  
Shoulder Stability

The shoulder is one of the most complex and often injured joints in the human body. The inferior glenohumeral ligament (IGHL), composed of the anterior band (AB), posterior band (PB) and the axillary pouch, has been shown to be an important contributor to anterior shoulder stability (Turkel, 1981). Injuries to the IGHL of the glenohumeral capsule are especially difficult to diagnose and treat effectively. The objective of this research was to develop a methodology for subject-specific finite element (FE) modeling of the ligamentous structures of the glenohumeral joint, specifically the IGHL, and to determine how changes in material properties affect predicted strains in the IGHL at 60° of external rotation. Using the techniques developed in this research, an improved understanding of the contribution of the IGHL to shoulder stability can be acquired.

Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes?

2021 ◽  
Author(s):  
Sean Mc Millan ◽  
Brian Fliegel ◽  
Michael Stark ◽  
Elizabeth Ford ◽  
Manuel Pontes ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Statistical Significance ◽  
Labral Repair ◽  
Secondary Outcome ◽  
Consecutive Series ◽  
Recurrent Instability ◽  
Significant Difference ◽  
Fixation Points ◽  
Definition Of ◽  
Shoulder Score

Introduction: The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of “one point of fixation” is yet to be fully elucidated. Materials and Methods: A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS). Results: There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively. Conclusion: Contention still exists surrounding the exact definition of “a point of fixation” in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.

scholarly journals Mini-open Repair of the Floating Anterior Inferior Glenohumeral Ligament: Combined Treatment of Bankart and Humeral Avulsion of the Glenohumeral Ligament Lesions

2018 ◽  
Vol 7 (12) ◽  
pp. e1281-e1287 ◽  
Author(s):  
Zachary S. Aman ◽  
Mitchell I. Kennedy ◽  
Anthony Sanchez ◽  
Joseph J. Krob ◽  
Colin P. Murphy ◽  
...  
Keyword(s):  
Open Repair ◽  
Combined Treatment ◽  
Glenohumeral Ligament ◽  
Inferior Glenohumeral Ligament ◽  
Mini Open
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