Abstract
Purpose
Recurrent shoulder dislocations can result in kinematic changes of the glenohumeral joint. The number of prior shoulder dislocations may contribute to increased severity of capsulolabral lesions. The kinematics of the glenohumeral joint following multiple dislocations remain poorly understood. The purpose of this study was to assess the kinematics of the glenohumeral joint during anterior dislocations of the shoulder, and more specifically, altered translational motion following multiple dislocations. The kinematics of the glenohumeral joint were hypothesized to change and correlate with the number of dislocations.
Methods
Eight fresh-frozen cadaveric shoulders were dissected free of all soft tissues except the glenohumeral capsule. Each joint was mounted in a robotic testing system. At 60 degrees of glenohumeral abduction, an internal and external rotational torque (1.1 Nm) were applied to the humerus, and the resulting joint kinematics were recorded. Anterior forces were applied to the humerus to anteriorly dislocate the shoulder and the resulting kinematics were recorded during each dislocation. Following each dislocation, the same rotational torque was applied to the humerus, and the resulting joint kinematics were also recorded. A repeated-measures analysis of variance (ANOVA) was used to compare the kinematics following each dislocation.
Results
During the 7th, 8th, 9th, and 10th dislocations, the humerus significantly translated superiorly compared with the shoulder during the 1st dislocation (p < 0.05). Following the 3rd, 4th, 5th, and 10th dislocations, the humeral head significantly translated superiorly compared with the shoulder following the 1st dislocation in the position of 60 degrees of abduction in response to external rotation torque (p < 0.05).
Conclusion
Multiple anterior shoulder dislocations lead to abnormal translational kinematics and result in increased superior translation of the humerus. This may contribute to pathologic superior extension of capsulolabral injuries. Superior translation of the humerus with overhead motion in the setting of recurrent instability may also place the shoulder at risk for extension of the capsulolabral injuries.
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Data Availability
All relevant data generated or analyzed during this study are included in this published article.
References
Alexeev M, Kercher JS, Levina Y, Duralde XA (2021) Variability of glenoid labral tear patterns: a study of 280 sequential surgical cases. J Shoulder Elbow Surg 30(12):2762–2766. https://doi.org/10.1016/j.jse.2021.05.004
Arner JW, Cooper JD, Elrick BP, Rakowski DR, Ruzbarsky JJ, Horan MP et al (2022) Outcomes of arthroscopic anterior labroligamentous periosteal sleeve avulsion lesions: a minimum 2-year follow-up. Am J Sports Med 50(6):1512–1519. https://doi.org/10.1177/03635465221090902
Arner JW, Peebles LA, Bradley JP, Provencher MT (2020) Anterior shoulder instability management: indications, techniques, and outcomes. Arthroscopy 36(11):2791–2793. https://doi.org/10.1016/j.arthro.2020.09.024
Burkart A, Debski RE, Musahl V, McMahon PJ (2003) Glenohumeral translations are only partially restored after repair of a simulated type II superior labral lesion. Am J Sports Med 31(1):56–63. https://doi.org/10.1177/03635465030310012101
Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 400:32–39
Chen KH, Chiang ER, Wang HY, Ma HL (2022) Anterior mid-portion capsular tear with bankart lesion in recurrent anterior shoulder dislocation: outcome report and bone defect evaluation. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04580-5
Culham E, Peat M (1993) Functional anatomy of the shoulder complex. J Orthop Sports Phys Ther 18(1):342–350. https://doi.org/10.2519/jospt.1993.18.1.342
Debski RE, Wong EK, Woo SL, Sakane M, Fu FH, Warner JJ (1999) In situ force distribution in the glenohumeral joint capsule during anterior-posterior loading. J Orthop Res 17(5):769–776. https://doi.org/10.1002/jor.1100170523
Dickens JF, Slaven SE, Cameron KL, Pickett AM, Posner M, Campbell SE et al (2019) Prospective evaluation of glenoid bone loss after first-time and recurrent anterior glenohumeral instability events. Am J Sports Med 47(5):1082–1089. https://doi.org/10.1177/0363546519831286
Feng S, Song Y, Li H, Chen J, Chen J, Chen S (2019) Outcomes for arthroscopic repair of combined bankart/slap lesions in the treatment of anterior shoulder instability: a systematic review and meta-analysis. Orthop J Sports Med 7(10):2325967119877804. https://doi.org/10.1177/2325967119877804
Kim DS, Yoon YS, Yi CH (2010) Prevalence comparison of accompanying lesions between primary and recurrent anterior dislocation in the shoulder. Am J Sports Med 38(10):2071–2076. https://doi.org/10.1177/0363546510371607
Krespi R, Maman E, Factor S, Benshabat D, Dolkart O, Ashkenazi I et al (2022) Combined bankart and slap repair: patient-reported outcome measurements after a minimum 5-year follow-up. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-022-04599-8
Ladd LM, Crews M, Maertz NA (2021) Glenohumeral joint instability: a review of anatomy, clinical presentation, and imaging. Clin Sports Med 40(4):585–599. https://doi.org/10.1016/j.csm.2021.05.001
Lo IK, Burkhart SS (2005) Triple labral lesions: pathology and surgical repair technique-report of seven cases. Arthroscopy 21(2):186–193. https://doi.org/10.1016/j.arthro.2004.09.022
Matsumura N, Kaneda K, Oki S, Kimura H, Suzuki T, Iwamoto T et al (2021) Factors related to large bone defects of bipolar lesions and a high number of instability episodes with anterior glenohumeral instability. J Orthop Surg Res 16(1):255. https://doi.org/10.1186/s13018-021-02395-5
McMahon PJ, Burkart A, Musahl V, Debski RE (2004) Glenohumeral translations are increased after a type II superior labrum anterior-posterior lesion: a cadaveric study of severity of passive stabilizer injury. J Shoulder Elbow Surg 13(1):39–44. https://doi.org/10.1016/j.jse.2003.09.004
McMahon PJ, Yang BY, Chow S, Lee TQ (2013) Anterior shoulder dislocation increases the propensity for recurrence: a cadaveric study of the number of dislocations and type of capsulolabral lesion. J Shoulder Elbow Surg 22(8):1046–1052. https://doi.org/10.1016/j.jse.2012.11.013
Mihata T, McGarry MH, Tibone JE, Fitzpatrick MJ, Kinoshita M, Lee TQ (2008) Biomechanical assessment of type ii superior labral anterior-posterior (slap) lesions associated with anterior shoulder capsular laxity as seen in throwers: a cadaveric study. Am J Sports Med 36(8):1604–1610. https://doi.org/10.1177/0363546508315198
Muraki T, Yamamoto N, Zhao KD, Sperling JW, Steinmann SP, Cofield RH et al (2010) Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med 38(3):600–607. https://doi.org/10.1177/0363546509350074
Provencher MT, Midtgaard KS, Owens BD, Tokish JM (2021) Diagnosis and management of traumatic anterior shoulder instability. J Am Acad Orthop Surg 29(2):e51–e61. https://doi.org/10.5435/jaaos-d-20-00202
Rainis EJ, Maas SA, Henninger HB, McMahon PJ, Weiss JA, Debski RE (2009) Material properties of the axillary pouch of the glenohumeral capsule: is isotropic material symmetry appropriate? J Biomech Eng 131(3):031007. https://doi.org/10.1115/1.3005169
Ro K, Kim MS, Kim JD, Rhee YG (2019) Arthroscopic findings and clinical outcomes in patients 40 years of age and older with recurrent shoulder dislocation. Arthroscopy 35(2):314–322. https://doi.org/10.1016/j.arthro.2018.08.041
Rutgers C, Verweij LPE, Priester-Vink S, van Deurzen DFP, Maas M, van den Bekerom MPJ (2022) Recurrence in traumatic anterior shoulder dislocations increases the prevalence of hill-sachs and bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30(6):2130–2140. https://doi.org/10.1007/s00167-021-06847-7
Sarıkaya B, Bozkurt C, Gül O, Bekin Sarıkaya PZ, Sipahioğlu S, Altay MA (2020) Comparison of the clinical results of isolated bankart and slap 5 lesions after arthroscopic repair. Jt Dis Relat Surg 31(2):223–229. https://doi.org/10.5606/ehc.2020.74750
Souleiman F, Zderic I, Pastor T, Varga P, Helfen T, Richards G et al (2022) Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability. Knee Surg Sports Traumatol Arthrosc 30(11):3626–3633. https://doi.org/10.1007/s00167-022-06968-7
Subramanian KN, Channabasappa Eswarappa D, Senthilnathan GP, Subramanian M, Sellappan R (2021) Arthroscopic nomenclature of capsulolabral appearances in anterior shoulder dislocation. J Orthop 25:120–123. https://doi.org/10.1016/j.jor.2021.03.016
Takenaga T, Yoshida M, Chan CK, Musahl V, Debski RE, Lin A (2022) Direction of non-recoverable strain in the glenohumeral capsule following multiple anterior dislocations: implications for anatomic bankart repair. J Orthop Res. https://doi.org/10.1002/jor.25385
Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23(9):985–990. https://doi.org/10.1016/j.arthro.2007.05.009
Yoshida M, Takenaga T, Chan CK, Musahl V, Debski RE, Lin A (2020) Location and magnitude of capsular injuries varies following multiple anterior dislocations of the shoulder: implications for surgical repair. J Orthop Res. https://doi.org/10.1002/jor.24860
Yoshida M, Takenaga T, Chan CK, Musahl V, Lin A, Debski RE (2019) Altered shoulder kinematics using a new model for multiple dislocations-induced bankart lesions. Clin Biomech (Bristol, Avon) 70:131–136. https://doi.org/10.1016/j.clinbiomech.2019.08.014
Acknowledgements
The Albert B. Ferguson Jr. MD, Orthopaedic Fund of the University of Pittsburgh and the University of Pittsburgh Medical Center Department of Orthopaedic Surgery.
Funding
This study was funded by The Albert B. Ferguson Jr. MD, Orthopaedic Fund of the Pittsburgh Foundation Grant and by the Department of Orthopaedic Surgery at the University of Pittsburgh Medical Center.
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CORID No. 131: The Dynamic Shoulder Model of Rotator Cuff and Ligament Function. Committee for Oversight of Research and Clinical Training Involving Decedents at University of Pittsburgh. CORID No. 131.
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Yoshida, M., Takenaga, T., Chan, C.K. et al. Increased superior translation following multiple simulated anterior dislocations of the shoulder. Knee Surg Sports Traumatol Arthrosc 31, 1963–1969 (2023). https://doi.org/10.1007/s00167-022-07257-z
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DOI: https://doi.org/10.1007/s00167-022-07257-z