scholarly journals Shoulder Positioning during Superior Capsular Reconstruction: Computational Analysis of Graft Integrity and Shoulder Stability

Biology ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1263
Author(s):  
Madalena Antunes ◽  
Carlos Quental ◽  
João Folgado ◽  
Clara de Campos Azevedo ◽  
Ana Catarina Ângelo
Keyword(s):  
Glenohumeral Joint ◽  
Reaction Force ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Joint Reaction Force ◽  
Superior Capsular Reconstruction ◽  
Key Factor ◽  
Long Head ◽  
Shoulder Position ◽  
Shoulder Stability

The shoulder position during fixation of the graft may be a key factor impacting the outcome of arthroscopic superior capsular reconstruction (ASCR) in irreparable rotator cuff tears (IRCTs). However, biomechanical evidence regarding this effect is lacking. The aim of this study was to evaluate the influence of the shoulder position during fixation of the graft on shoulder stability and graft tear risk in ASCR. A 3-D musculoskeletal model of the upper limb was modified to account for the fixation of the graft in ASCR, assuming a full-thickness tear of the supraspinatus tendon. The concomitant tenotomy of the long head of the biceps (LHB) tendon was also studied. The biomechanical parameters evaluated included the strain of the graft and the glenohumeral joint reaction force (GH JRF), which were used to evaluate graft integrity and shoulder stability, respectively. Fixation of the graft considering abduction angles greater than 15° resulted in a high risk for graft tearing when the arm was adducted to the side of the trunk. For abduction angles below 15°, the mean shoulder stability improved significantly, ranging between 6% and 20% (p < 0.001), compared with that in the preoperative condition. The concomitant tenotomy of the LHB tendon resulted in loss of stability when compared to ASCR with an intact LHB tendon. The position of the shoulder during fixation of the graft has a significant effect on shoulder stability and graft tear risk after ASCR in IRCTs. This study provides new and important information regarding the role of shoulder positioning during fixation of the graft.

scholarly journals The Evolution and Role of the Bursal Acromial Reconstruction

2021 ◽  
Vol 1 (2) ◽  
pp. 263502542110013
Author(s):  
Daniel M. Curtis ◽  
W. Michael Pullen ◽  
Kevin Helenius ◽  
Michael T. Freehill
Keyword(s):  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Treatment Options ◽  
Clinical Problem ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Promising Alternative ◽  
Diagnostic Arthroscopy ◽  
Superior Capsular Reconstruction

Background: Massive, irreparable rotator cuff tears (RCTs) remain a challenging clinical problem with numerous described treatment options. Bursal acromial reconstruction (BAR) represents a promising and evolving technique for a subset of patients with irreparable RCTs. Indications: BAR is indicated for patients with massive, irreparable RCTs with a primary complaint of pain, well-compensated shoulder function, and minimal radiographic degenerative changes of the glenohumeral joint as an alternative to reverse total shoulder arthroplasty or superior capsular reconstruction. Technique Description: Positioning per surgeon preference and diagnostic arthroscopy is performed. Subacromial decompression with a minimal and gentle acromioplasty is performed, followed by assessment of RCT repairability. If the tear is deemed irreparable, acromial measurements in the medial-lateral and anterior-posterior dimensions are obtained. Two pieces of acellular dermal allograft are cut to the acromial dimensions and affixed together using fibrin glue. The reactive side (facing the acromion), medial, and anterior sides of the graft are labeled. Two suture tapes are passed through the corners of the graft and self-locked and run diagonally in a cruciate configuration using an antegrade suture passer. Medial and lateral #2 fiberwire sutures are placed in a luggage-tag configuration. Neviaser (posterior), middle, and anterior acromioclavicular joint portals are created for medial sided suture passage. Medial graft sutures are shuttled through the respective medial portals and the graft is pulled into the subacromial space. The lateral sutures are then removed from percutaneous posterolateral, middle lateral, and anterolateral portals along the acromial edge. Medial sutures are retrieved using a suture grasper subcutaneously on top of the acromion through the percutaneous lateral portals. The sutures are tied through the lateral portals, starting with the medial-lateral sutures, and the knots are buried. Postoperatively, patients are progressed through passive, active-assisted, and active range of motion between weeks 2 and 6 and strengthening is progressed at 6 weeks. Results: Clinical results are lacking in the literature, but anecdotal results in our institution have demonstrated promising early outcomes. Discussion/Conclusion: BAR represents a promising alternative in the array of surgical options for treatment of irreparable RCTs.

scholarly journals Shoulder biomechanics in normal and selected pathological conditions

2020 ◽  
Vol 5 (8) ◽  
pp. 508-518
Author(s):  
Patrick Goetti ◽  
Patrick J. Denard ◽  
Philippe Collin ◽  
Mohamed Ibrahim ◽  
Pierre Hoffmeyer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Biceps Tendon ◽  
Tendon Healing ◽  
Upward Migration ◽  
Superior Capsular Reconstruction ◽  
Long Head ◽  
Favourable Environment ◽  
The Stability ◽  
Cuff Repair

The stability of the glenohumeral joint depends on soft tissue stabilizers, bone morphology and dynamic stabilizers such as the rotator cuff and long head of the biceps tendon. Shoulder stabilization techniques include anatomic procedures such as repair of the labrum or restoration of bone loss, but also non-anatomic options such as remplissage or tendon transfers. Rotator cuff repair should restore the cuff anatomy, reattach the rotator cable and respect the coracoacromial arch whenever possible. Tendon transfer, superior capsular reconstruction or balloon implantation have been proposed for irreparable lesions. Shoulder rehabilitation should focus on restoring balanced glenohumeral and scapular force couples in order to avoid an upward migration of the humeral head and secondary cuff impingement. The primary goal of cuff repair is to be as anatomic as possible and to create a biomechanically favourable environment for tendon healing. Cite this article: EFORT Open Rev 2020;5:508-518. DOI: 10.1302/2058-5241.5.200006

scholarly journals Irreparable Rotator Cuff Tears: A Biomechanical Comparison of Superior Capsuloligamentous Complex Reconstruction Techniques and an Interpositional Graft Technique

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986459 ◽  
Author(s):  
Tim Leschinger ◽  
Katharina Besch ◽  
Cansu Aydin ◽  
Manfred Staat ◽  
Martin Scaal ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Glenohumeral Joint ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Neutral Position ◽  
Management Options ◽  
Significant Difference ◽  
Intact Condition ◽  
Point Condition ◽  
Biomechanical Comparison

Background: Irreparable rotator cuff tears lead to superior translation of the humeral head. Numerous surgical management options are available to treat the condition. Purpose: To compare superior capsule stability among different types of patch grafting in irreparable rotator cuff tears. Methods: Six cadaveric shoulders were tested in a custom-designed shoulder testing system. Superior translation of the humerus and subacromial contact pressure were quantified in an intact condition (condition 1), after cutting the supraspinatus tendon (condition 2), and after additionally cutting the superior capsuloligamentous complex (condition 3). The results were compared among 3 types of patch grafting, in which capsule reconstruction was achieved by glenoidal 3-point (condition 4) or 2-point (condition 5) fixation or by affixing a graft below the acromion (condition 6). Results: No significant difference in subacromial pressure was measured by reconstruction with 2 or 3 anchors compared with conditions 1 and 2 ( P > .05). However, with 3-point fixation, lower levels of pressure were measured than with 2-point fixation. Moreover, superior translation values were lower with 3-point fixation; the same applied for values of the preserved capsule as compared with the torn capsule. In condition 6, a significant increase in pressure in the neutral position was documented ( P < .05). Conclusion: The superior capsuloligamentous complex plays an important role in stabilizing the glenohumeral joint. The results suggest that with additional medial anchoring at the coracoid base, the depressing and centering effect of the superior complex can probably be regained in a more physiological way compared with a reconstructed capsule with 2 glenoid attachments or with an interpositional graft below the acromion.

scholarly journals The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal

2021 ◽  
Vol 8 ◽  
Author(s):  
Pierfrancesco Luciani ◽  
Luca Farinelli ◽  
Luca De Berardinis ◽  
Antonio Gigante
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Biceps Tendon ◽  
Reverse Shoulder Arthroplasty ◽  
Supraspinatus Tendon ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Injuries ◽  
Superior Capsular Reconstruction ◽  
Significant Difference

Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure.Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM).Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system.Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario.Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM.Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.

Instability

2011 ◽  
Author(s):  
Simon M. Lambert
Keyword(s):  
Glenohumeral Joint ◽  
Reaction Force ◽  
Fundamental Principle ◽  
Rehabilitation Program ◽  
Clinical Syndrome ◽  
Structural Factors ◽  
Relative Importance ◽  
Joint Reaction Force ◽  
Rehabilitation Programs ◽  
The Relationship

♦ The fundamental principle or essence of the shoulder is concavity compression. Stability of the shoulder is the condition in which a balanced centralizing joint reaction force (CJRF) exists to maintain concavity compression of the glenohumeral joint whatever the position of the limb and hand.♦ Instability is a symptom. It can be defined as the condition of symptomatic abnormal motion of the joint. It refers to a perturbation of concavity compression. It is not a diagnosis.♦ Instability is the result of perturbations of structural factors and non-structural factors.♦ The clinical syndrome of instability is a disturbance of one or more of these factors in isolation or together. The relative importance of each factor to the syndrome can change over time. The relationship between these factors is described by the Stanmore triangle.♦ Both structural and non-structural factors can be perturbed by arrested or incomplete development (dysplasia) or by injury (disruption).♦ The aim of treatment is the restoration of (asymptomatic) stable motion by restoration of the CJRF and so restoration of the condition of concavity compression.♦ Management follows simple principles: surgery should be undertaken within the context of a well-considered rehabilitation program largely centred around optimizing rotator cuff function.♦ Failures of management are often due to failure of or incomplete diagnosis, failure of healing, inadequate attention to patient- and pathology- specific rehabilitation programs, or insufficient attention to lifestyle considerations.♦ Disrupted anatomy is restored, preferably by anatomic operations with predictably good outcomes. Dysplastic anatomy is augmented, often by non-anatomic operations with less predictable outcomes. Revision stabilizations are generally nonanatomic, and have higher failure rates.

Calculation of muscle forces and joint reaction loads in the shoulder area via an OpenSim based computer model

2018 ◽  
Vol 85 (5) ◽  
pp. 321-330 ◽  
Author(s):  
Stefan Birgel ◽  
Tim Leschinger ◽  
Kilian Wegmann ◽  
Manfred Staat
Keyword(s):  
Computer Model ◽  
Reaction Force ◽  
Supraspinatus Tendon ◽  
Muscle Forces ◽  
Joint Stability ◽  
Muscle Attachment ◽  
Joint Reaction Force ◽  
Biomechanical Parameters ◽  
Muscle Activations ◽  
Joint Reaction

Abstract Using the OpenSim software and verified anatomical data, a computer model for the calculation of biomechanical parameters is developed and used to determine the effect of a reattachment of the Supraspinatus muscle with a medial displacement of the muscle attachment point, which may be necessary for a rupture of the supraspinatus tendon. The results include the influence of the operation on basic biomechanical parameters such as the lever arm, as well as the calculated the muscle activations for the supraspinatus and deltoid. In addition, the influence on joint stability is examined by an analysis of the joint reaction force. The study provides a detailed description of the used model, as well as medical findings to a reattachment of the supraspinatus.

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