Biomechanical effects of arthroscopic capsulorrhaphy in line with the fibers of the anterior band of the inferior glenohumeral ligament.
ABSTRACT There is no consensus as to the amount and direction of capsular plication necessary to correct anterior shoulder instability without overconstraining the joint.
An arthroscopic capsulorrhaphy in line with the fibers of the inferior glenohumeral ligament (IGHL) in an anterior laxity model will restore glenohumeral kinematics to normal.
Controlled laboratory study.
Six cadaveric specimens were tested in both the scapular and coronal plane in 3 conditions: intact, anterior instability, and plicated. The anterior instability model was created by stretching the shoulder 20% beyond the physiological external rotational range of motion, and plication was achieved by performing a 10-mm arthroscopic plication in line with the fibers of the anterior band of the IGHL.
Stretching significantly increased the rotational range of motion, while plication restored it back to that of the intact condition (P < .05). There were few significant changes in humeral head apex position across all 3 testing conditions. Plication significantly reduced anterior translation compared with the stretched condition (P < .05). Stretching and plication both significantly reduced contact area relative to the intact condition (P < .05). There were no significant differences between any of the 3 conditions for contact pressure and only few significant differences between the conditions for contact peak pressure.
A 10-mm capsular plication in line with the fibers of the anterior band of the IGHL effectively reduces capsular laxity without overconstraining the joint.
The fibers of the anterior band of the IGHL provide a useful arthroscopic anatomic landmark for the direction of anterior capsulorrhaphy.
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ABSTRACT: Extensive glenoid bone loss after failed shoulder arthroplasty represents a challenge for revision arthroplasty. Treatment options vary widely and have been a source of controversy among experts. Between 2004 and 2010, a total of 17 patients underwent glenoid reconstruction surgery using an autologous iliac crest bone graft and secondary revision arthroplasty due to extensive glenoid bone loss after failed previous total shoulder arthroplasty. The outcomes were assessed by means of clinical examination, Constant score, and bi-plane radiography as well as pre-, postoperative and follow-up CT. Before the revision surgery, the mean Constant score was 24 ± 17 and improved to 40 ± 13 after the glenoid rebuilding and revision arthroplasty. CT imaging revealed adequate glenoid bone stock restoration with no relevant graft resorption or loosening of the glenoid. The average postoperative antero-posterior diameter of the glenoid was 28 ± 3 mm which had decreased to 25 ± 3 mm at follow-up. The average postoperative version of the glenoid was 95.7° ± 6° and had decreased to 98.5° ± 4° at follow-up. Both the glenoid version and diameter had changed significantly (P < 0.001) comparing postoperative and follow-up CT-scans. Glenoid reconstruction surgery using an iliac crest bone-block autograft prior to revision arthroplasty represents a valuable salvage procedure in cases of extensive glenoid bone loss after primary shoulder arthroplasty. Sufficient glenoid bone stock restoration is indispensable for reliable fixation of glenoid components and in turn a satisfactory clinical outcome.International Orthopaedics 12/2013; 38(4). DOI:10.1007/s00264-013-2191-z · 2.02 Impact Factor