The Superior Glenohumeral Joint Capsule Alone Does Not Prevent Superior Translation of the Humeral Head: An In Vitro Biomechanical Study

Hu, Qingxiang; Ding, Zhenyu; Zhang, Haoyu; He, Yaohua

doi:10.1016/j.arthro.2018.06.025

Cited by 15 publications

(6 citation statements)

References 37 publications

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“…A subsequent editorial review of that article by Verma et al 3 questions the possibility of an essential lesion, as has been reported in glenohumeral instability. A recent basic science study by Hu et al 4 may provide additional guidance, or confusion. They attempted to identify whether it is the supraspinatus or superior capsule that is the main structure that prevents superior translation; ultimately, they concluded that "the anatomic superior capsule has a negligible role in preventing the superior translation of the humeral head."…”

Section: See Related Article On Page 1243mentioning

confidence: 99%

“…Because the recommendation is to secure the graft in some glenohumeral abduction, this is clearly not a true anatomical reconstruction if we choose both native capsular thickness and tension as determinants. Hu et al 4 suggest that the graft could function through 2 mechanisms by providing either a spacer effect, a tensional hammock effect, or some combination of both. So, which is it?…”

Section: See Related Article On Page 1243mentioning

confidence: 99%

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Editorial Commentary: SCR: Substantial Confusion Remains

Favorito¹,

Stephens²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: See Related Article On Page 1243mentioning

confidence: 99%

Section: See Related Article On Page 1243mentioning

confidence: 99%

Editorial Commentary: SCR: Substantial Confusion Remains

Favorito¹,

Stephens²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…However, only a few studies have evaluated clinical outcomes after superior capsular reconstruction. 4,20 Hu et al 16 reported that superior capsule plays a negligible role in preventing superior translation of the humeral head. Several studies have shown high failure rates and less satisfactory functional outcomes with the use of bridging grafts.…”

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confidence: 99%

Comparing Clinical Outcomes After Subacromial Spacer Insertion Versus Other Reconstruction Methods in the Treatment of Irreparable Massive Rotator Cuff Tears

Park

Jeong

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Previous studies on subacromial spacer (SAS) insertion have been limited to case series that did not compare the effectiveness of this technique with other techniques. Hypothesis: Outcomes after SAS insertion for the treatment of irreparable massive rotator cuff tears (IMRCTs) will be similar to those of other techniques. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study was based on data collected from patients who underwent correction of IMRCTs between January 2010 and October 2017. Group 1 patients (n = 17) received SAS insertion with or without partial repair; group 2 patients (n = 36) were treated with other techniques (isolated partial repairs or bridging grafts). Preoperative tear size and global fatty degeneration index values were evaluated. Range of motion, visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Simple Shoulder Test (SST), Disabilities of the Arm, Shoulder and Hand score, and acromiohumeral distance (AHD) were assessed preoperatively and at final follow-up at least 2 years after the surgery (range, 24-60 months). In both groups, ultrasonographic examination was performed at 3 and 6 months postoperatively, and magnetic resonance imaging (MRI) was performed at 1 year. Results: Tear size and preoperative global fatty degeneration index were not significantly different between the groups (all P > .05). There were no differences in functional scores between the groups at final follow-up (all P > .05). AHD was maintained at final follow-up in group 1 (mean ± SD: 6.2 ± 2.1 mm [postoperatively] vs 6.7 ± 2.3 mm [final follow-up]; P = .678), and there was no difference compared with group 2 (7.2 ± 3.2 mm; P = .244). Patients with retears in group 2 (23 of 36, 63.9%) had lower ASES ( P = .041) and SST ( P = .027) scores at final follow-up when compared with patients in group 1. Six patients (35.3%) in group 1 had partial repairs; these patients had better external rotation at 90° ( P = .047), better SST scores ( P = .036), and higher AHDs at final follow-up ( P = .046) than those in group 1 who had no repair. Three patients (50%) showed retears of partially repaired tendons on MRI. Of 13 patients (76.5%) in group 1 with postoperative MRI, 12 (92.3%) showed fibrotic tissue in the subacromial space not seen preoperatively. Conclusion: There was no difference in outcomes between SAS and the other reconstruction methods for treating IMRCTs. However, given the high retear rate associated with other techniques and poor functional outcomes after retear, SAS insertion could be a viable option for treating IMRCTs.

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“…We wish to register our disagreement with the conclusions of Hu, Ding, Zhang, and He in their recent article entitled, "The Superior Glenohumeral Joint Capsule Alone Does Not Prevent Superior Translation of the Humeral Head: An In Vitro Biomechanical Study." 1 In that article, the authors concluded that "the anatomic superior capsule has a negligible role in preventing the superior translation of the humeral head. " We believe that there are serious flaws in the authors' study design and methodology that led to their erroneous conclusions.…”

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confidence: 99%

“…If one examines the 6 testing models used by Hu et al (intact joint; supraspinatus dysfunction; supraspinatus defect; superior capsule tear; superior capsular defect; and irreparable rotator cuff tear), they all have only 2 possible ways to resist proximal humeral translation: (1) tensile resistance (what the authors call "the tensional hammock effect"); and (2) a spacer effect. The "tensional hammock effect would resist proximal migration of the humerus by means of a tensile force that is developed within the superior capsule, or the supraspinatus tendon, or both.…”

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confidence: 99%