The Effect of Glenohumeral Fixation Angle on Deltoid Function During Superior Capsule Reconstruction: A Biomechanical Investigation

Adams, Christopher R.; Comer, Brendan; Scheiderer, Bastian; Imhoff, Florian B.; Morikawa, Daichi; Kia, Cameron; Muench, Lukas N.; Baldino, Joshua B.; Mazzocca, Augustus D.

doi:10.1016/j.arthro.2019.09.011

Cited by 29 publications

(71 citation statements)

References 26 publications

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“…Specimen preparation was performed according to a previously described method. 1,15,47 Specimens were thawed overnight at room temperature before dissection. Specimens were then dissected free of skin, subcutaneous tissue, and muscles, leaving the rotator cuff muscles and the coracoacromial ligament carefully preserved.…”

Section: Methodsmentioning

confidence: 99%

“…2 FiberWire; Arthrex Inc), allowing for attachment of each of the 3 deltoid heads to an individual shoulder simulator actuator. 1,15,47 The rotator cuff muscles (supraspinatus [SSP], subscapularis [SSC], infraspinatus [ISP], and teres minor [TM]) were sharply released from the scapula and separated from the underlying capsule, while meticulously preventing disruption of the tissue. The ISP and TM were simulated as 1 unit as previously described.…”

Section: Methodsmentioning

confidence: 99%

“…The scapular body was placed in a custom rectangular box with the medial border aligned perpendicular to the ground and the glenoid tilted 10° superiorly, and bone cement was poured in to ensure proper fixation. 1,15,20,47,53 A steel rod was cemented into the distal humerus and loaded with 1.7 kg 30 cm distal from the center of the humeral head, representing a constant moment arm for each tested shoulder. 22,53 The glenohumeral joint capsule was vented by opening the rotator interval to prevent changes during testing.…”

Section: Methodsmentioning

confidence: 99%

“…22,53 The glenohumeral joint capsule was vented by opening the rotator interval to prevent changes during testing. 1,15,47…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

et al. 2021

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Background: In the past decade, superior capsular reconstruction has emerged as a potential surgical approach in young patients with irreparable posterosuperior rotator cuff tears (RCT) and absence of severe degenerative changes. Recently, the use of locally available and biological viable autografts, such as the long head of the biceps tendon (LHBT) for SCR has emerged, with promising early results. Purpose/Hypothesis: The purpose of this study was to investigate the effect of using the LHBT for reconstruction of the superior capsule on shoulder kinematics, along with different fixation constructs in a dynamic biomechanical model. The authors hypothesized that each of the 3 proposed fixation techniques would restore native joint kinematics, including glenohumeral superior translation (ghST), maximum abduction angle (MAA), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP). Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders (mean age, 53.4 ± 14.2 years) were tested using a dynamic shoulder simulator. Each specimen underwent the following 5 conditions: (1) intact, (2) irreparable posterosuperior rotator cuff tear (psRCT), (3) V-shaped LHBT reconstruction, (4) box-shaped LHBT reconstruction, and (5) single-stranded LHBT reconstruction. MAA, ghST, cDF and sCP were assessed in each tested condition. Results: Each of the 3 LHBT techniques for reconstruction of the superior capsule significantly increased MAA while significantly decreasing ghST and cDF compared with the psRCT ( P < .001 and P < .001, respectively). Additionally, the V-shaped and box-shaped techniques significantly decreased sCP ( P = .009 and P = .016, respectively) compared with the psRCT. The V-shaped technique further showed a significantly increased MAA ( P < .001, respectively) and decreased cDF ( P = .042 and P = .039, respectively) when compared with the box-shaped and single-stranded techniques, as well as a significantly decreased ghST ( P = .027) when compared with the box-shaped technique. Conclusion: In a dynamic biomechanical cadaveric model, using the LHBT for reconstruction of the superior capsule improved shoulder function by preventing superior humeral migration, decreasing deltoid forces and sCP. As such, the development of rotator cuff tear arthropathy in patients with irreparable psRCTs could potentially be delayed. Clinical Relevance: Using a biologically viable and locally available LHBT autograft is a cost-effective, potentially time-saving, and technically feasible alternative for reconstruction of the superior capsule, which may result in favorable outcomes in irreparable psRCTs. Moreover, each of the 3 techniques restored native shoulder biomechanics, which may help improve shoulder function by preventing superior humeral head migration and the development of rotator cuff tear arthropathy in young patients with irreparable rotator cuff tears.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…22,53 The glenohumeral joint capsule was vented by opening the rotator interval to prevent changes during testing. 1,15,47…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

et al. 2021

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“…A power analysis was performed to determine detectable differences in the dependent variables given estimated standard deviations. 2 , 43 For the glenohumeral abduction angle, an error variance of 1° across all conditions with a correlation of 0.3 between measurements was assumed. A sample size of 6 specimens would provide 80% power to detect a 1° difference in shoulder angle at an α level of .05.…”

Section: Methodsmentioning

confidence: 99%

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Dyrna

Berthold

Muench

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears has become more widely used recently; however, ideal tensioning of the graft and the influence on joint kinematics remain unknown. Purpose/Hypothesis: The purpose of this study was to assess the effects of graft tensioning on glenohumeral joint kinematics after SCR using a dermal allograft. The hypothesis was that a graft fixed under tension would result in increased glenohumeral abduction motion and decreased cumulative deltoid forces compared with a nontensioned graft. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a dynamic shoulder simulator. Each shoulder underwent the following 4 conditions: (1) native, (2) simulated irreparable supraspinatus (SSP) tear, (3) SCR using a nontensioned acellular dermal allograft, and (4) SCR using a graft tensioned with 30 to 35 N. Mean values for maximum glenohumeral abduction and cumulative deltoid forces were recorded. The critical shoulder angle (CSA) was also assessed. Results: Native shoulders required a mean (±SE) deltoid force of 193.2 ± 45.1 N to achieve maximum glenohumeral abduction (79.8° ± 5.8°). Compared with native shoulders, abduction decreased after SSP tears by 32% (54.3° ± 13.7°; P = .04), whereas cumulative deltoid forces increased by 23% (252.1 ± 68.3 N; P = .04). The nontensioned SCR showed no significant difference in shoulder abduction (54.1° ± 16.1°) and required deltoid forces (277.8 ± 39.8 N) when compared with the SSP tear state. In contrast, a tensioned graft led to significantly improved shoulder abduction compared with the SSP tear state ( P = .04) although abduction and deltoid forces could not be restored to the native state ( P = .01). A positive correlation between CSA and maximum abduction was found for the tensioned-graft SCR state ( r = 0.685; P = .02). Conclusion: SCR using a graft fixed under tension demonstrated a significant increase in maximum shoulder abduction compared with a nontensioned graft; however, abduction remained significantly less than the intact state. The nontensioned SCR showed no significant improvement in glenohumeral kinematics compared with the SSP tear state. Clinical Relevance: Because significant improvement in shoulder function after SCR may be expected only when the graft is adequately tensioned, accurate graft measurement and adequate tension of at least 30 N should be considered during the surgical procedure. SCR with a tensioned graft may help maintain sufficient acromiohumeral distance, improve clinical outcomes, and reduce postoperative complications.

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Recentering the humeral head does not necessarily improve glenohumeral abduction: A cadaveric biomechanical study

Hu,

Li,

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo explore if recentering the humeral head could improve shoulder abduction in shoulders with irreparable massive rotator cuff tears (IMRCTs).MethodsNine fresh‐frozen cadaveric shoulders were used to simulate the intact condition and IMRCTs as controls. Four ‘recenter’ interventions were then sequentially applied: subacromial interposition (SI) using 4‐ and 8‐mm spacers and superior capsule reconstruction (SCR) using two‐ and four‐layer fascia lata grafts. Dynamic biomechanical experiments were performed for each condition. The primary outcomes were glenohumeral abduction angle (GAA). The secondary outcomes were acromiohumeral distance (AHD) and subacromial contact pressure.ResultsIn the intact condition, the GAA was significantly greater compared to the IMRCT condition at most deltoid force levels (p < 0.05 for all except at 80 N). IMRCT significantly increased maximum contact pressure (MCP) compared to intact (Δ +0.09 MPa, p = 0.029). For recentering interventions, neither SI nor SCR improved GAA (p > 0.05). The 8‐mm spacer and four‐layer SCR condition significantly increased MCP compared to the intact condition (Δ +0.22 MPa, p = 0.048, Δ +0.24 MPa, p = 0.012, respectively).ConclusionBoth SCR and SI could effectively recenter the humeral head, but neither technique improved shoulder abduction, with both even significantly increasing subacromial contact pressures. These findings suggest that surgical goals focusing solely on recentering humeral head may need re‐evaluation, particularly, for patients with high functional demands on shoulder abduction.Level of EvidenceN/A.

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The Effect of Glenohumeral Fixation Angle on Deltoid Function During Superior Capsule Reconstruction: A Biomechanical Investigation

Cited by 29 publications

References 26 publications

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Recentering the humeral head does not necessarily improve glenohumeral abduction: A cadaveric biomechanical study

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