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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 17, Issue 12, pp 1493–1499 | Cite as

Biomechanical stability of an arthroscopic anterior capsular shift and suture anchor repair in anterior shoulder instability: a human cadaveric shoulder model

  • Michael BohnsackEmail author
  • Benjamin Bartels
  • Sven Ostermeier
  • Oliver Rühmann
  • Matthias Wellmann
  • Farhad Mansouri
  • Christof Hurschler
Shoulder

Abstract

It was hypothesized that an arthroscopic Bankart repair with suture anchors supplies sufficient anterior shoulder stability, which cannot be improved by an additional capsular shift. In an experimental biomechanical human cadaver study, we tested ten fresh human cadaver shoulders in a robot-assisted shoulder simulator. External rotation and glenohumeral translation were measured at 0° and 80° of glenohumeral abduction. All measurements were performed under the following conditions: on the non-operated shoulder; following the setting of three arthroscopic portals; following an arthroscopic anterior capsular shift; following a simulated Bankart lesion; and following an arthroscopic Bankart repair. The application of three arthroscopic portals resulted in a significant increase of the anterior (P = 0.01) and antero-inferior translation (P = 0.03) at 0° and 80° abduction, as well as an increase in external rotation at 80° abduction (P = 0.03). Capsular shift reduced external rotation (P = 0.03), but did not significantly decrease translation. Simulating anterior shoulder instability, glenohumeral translation significantly increased, ranging from 50 to 279% of physiological translation. Arthroscopic shoulder stabilization resulted in a decrease of translation in all tested directions to approximately physiologic levels. External rotation in 0° abduction was thus decreased significantly (P = 0.003) to an average of 19°. The study proved that an arthroscopic anterior capsular shift in a cadaveric model decreases external rotation without a significant influence on glenohumeral translation. Arthroscopic shoulder stabilization with suture anchors thus sufficiently restores increased glenohumeral translation, but also decreases external rotation in neutral abduction. An anatomic reconstruction of the Bankart lesion without overconstraining of the antero-inferior capsule should therefore be the aim in arthroscopic anterior shoulder stabilization.

Keywords

Arthroscopic Bankart repair Capsular shift Biomechanical testing Glenohumeral translation External rotation 

Notes

Acknowledgments

The authors would like to thank the Arthrex Company of Naples, Florida, USA, for providing the arthroscopic equipment, the suture anchors and sutures, as well as granting funding for attaining the cadaver shoulders used in this study.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Michael Bohnsack
    • 1
    • 2
    Email author
  • Benjamin Bartels
    • 1
  • Sven Ostermeier
    • 3
  • Oliver Rühmann
    • 4
  • Matthias Wellmann
    • 3
  • Farhad Mansouri
    • 3
  • Christof Hurschler
    • 3
  1. 1.Department of Orthopaedic and Trauma SurgeryDIAKO Ev. Diakonie-KrankenhausBremenGermany
  2. 2.Department of Orthopaedic and Trauma SurgeryDIAKO Ev. Diakonie-KrankenhausBremenGermany
  3. 3.Department of Orthopaedic SurgeryHannover Medical SchoolHannoverGermany
  4. 4.Department of Orthopaedic and Trauma SurgeryAgnes-Karll-KrankenhausHannoverGermany

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