Skip to main content

Advertisement

SpringerLink
Log in

Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine the effect of a stepwise arthroscopic anterior plication and arthroscopic-equivalent rotator interval (RI) closure on glenohumeral range of motion, kinematics, and translation in the setting of anterior instability.

Methods

Six cadaveric shoulders were stretched to 10 % beyond maximum external rotation (ER) to create an anterior shoulder instability model. Range of motion, kinematics, and glenohumeral translations were recorded for the following conditions: (1) intact, (2) stretched, (3) after anterior capsular plication, and (4) after RI closure.

Results

The total range of motion after capsular stretching increased significantly in the 60° abduction position (p = 0.037). Average ER and total rotation were significantly decreased from the intact and stretched conditions by both repair conditions at 60° and 0° of glenohumeral abduction (p < 0.05), with no significant difference between plication and additional RI closure. At 0° abduction and 0° ER, glenohumeral translation decreased significantly from the stretched condition after RI closure with 10 and 15 N anterior and 10 N posterior loads (p < 0.05). At 30° ER, translation after RI closure was significantly less than both the intact and stretched conditions with 10 N anterior loads (p = 0.009; p = 0.004). These changes in translational stability were not seen with plication alone.

Conclusions

Anterior capsular plication reduced glenohumeral range of motion back to the intact state, and often tighter. RI closure did not contribute significantly to the reduction in the range of motion, but had implications regarding glenohumeral translation. Caution should be taken when performing anterior plication and combined repairs to avoid overtightening. Intraoperative translations could be useful when debating RI closure in patients with unidirectional anterior glenohumeral instability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Ando A, Sugaya H, Takahashi N, Kawai N, Hagiwara Y, Itoi E (2012) Arthroscopic management of selective loss of external rotation after surgical stabilization of traumatic anterior glenohumeral instability: arthroscopic restoration of anterior transverse sliding procedure. Arthroscopy 28(6):749–753

    Article  PubMed  Google Scholar 

  2. Borsa PA, Laudner KG, Sauers EL (2008) Mobility and stability adaptations in the shoulder of the overhead athlete: a theoretical and evidence-based perspective. Sports Med 38(1):17–36

    Article  PubMed  Google Scholar 

  3. Brophy RH, Marx RG (2009) The treatment of traumatic anterior instability of the shoulder: nonoperative and surgical treatment. Arthroscopy 25(3):298–304

    Article  PubMed  Google Scholar 

  4. Cole BJ, Romeo AA (2001) Arthroscopic shoulder stabilization with suture anchors: technique, technology, and pitfalls. Clin Orthop Relat Res 390:17–30

    Article  PubMed  Google Scholar 

  5. D’Alessandro DF, Bradley JP, Fleischli JE, Connor PM (2004) Prospective evaluation of thermal capsulorrhaphy for shoulder instability. Am J Sports Med 32(1):21–33

    Article  PubMed  Google Scholar 

  6. Dumont GD, Russell RD, Robertson WJ (2011) Anterior shoulder instability: a review of pathoanatomy, diagnosis and treatment. Curr Rev Musculoskelet Med 4(4):200–207

    Article  PubMed Central  PubMed  Google Scholar 

  7. Farber AJ, ElAttrache NS, Tibone JE, McGarry MH, Lee TQ (2009) Biomechanical analysis comparing a traditional superior-inferior arthroscopic rotator interval closure with a novel medial-lateral technique in a cadaveric multidirectional instability model. Am J Sports Med 37(6):1178–1185

    Article  PubMed  Google Scholar 

  8. Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL (1995) Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 23(5):557–563

    Article  CAS  PubMed  Google Scholar 

  9. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF (1995) Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med 23(2):233–239

    Article  CAS  PubMed  Google Scholar 

  10. Gillis RC, Donaldson CT, Kim H, Love JM, Dreese JC (2012) Arthroscopic suture anchor capsulorrhaphy versus labral-based suture capsulorrhaphy in a cadaveric model. Arthroscopy 28(11):1615–1621

    Article  PubMed  Google Scholar 

  11. Good CR, Shindle MK, Kelly BT, Wanich T, Warren RF (2007) Glenohumeral chondrolysis after shoulder arthroscopy with thermal capsulorrhaphy. Arthroscopy 23(7):797.e791–797.e795

    Article  Google Scholar 

  12. Handoll H, Almaiyah M, Rangan A (2004) Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev 1:CD004325

    PubMed  Google Scholar 

  13. Jones KJ, Kahlenberg CA, Dodson CC, Nam D, Williams RJ, Altchek DW (2012) Arthroscopic capsular plication for microtraumatic anterior shoulder instability in overhead athletes. Am J Sports Med 40(9):2009–2014

    Article  PubMed  Google Scholar 

  14. Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9(4):336–341

    Article  CAS  PubMed  Google Scholar 

  15. Karas SG (2002) Arthroscopic rotator interval repair and anterior portal closure. Arthroscopy 18(4):436–439

    Article  PubMed  Google Scholar 

  16. Kvitne RS, Jobe FW (1993) The diagnosis and treatment of anterior instability in the throwing athlete. Clin Orthop Relat Res 291:107–123

    PubMed  Google Scholar 

  17. Laudner K, Meister K, Noel B, Deter T (2012) Anterior glenohumeral laxity is associated with posterior shoulder tightness among professional baseball pitchers. Am J Sports Med 40(5):1133–1137

    Article  PubMed  Google Scholar 

  18. Lee HJ, Kim NR, Moon SG, Ko SM, Park JY (2012) Multidirectional instability of the shoulder: rotator interval dimension and capsular laxity evaluation using MR arthrography. Skeletal Radiol 42(2):231–238

    Article  PubMed  Google Scholar 

  19. Luke TA, Rovner AD, Karas SG, Hawkins RJ, Plancher KD (2004) Volumetric change in the shoulder capsule after open inferior capsular shift versus arthroscopic thermal capsular shrinkage: a cadaveric model. J Shoulder Elbow Surg 13(2):146–149

    Article  PubMed  Google Scholar 

  20. Mihata T, Gates J, McGarry MH, Neo M, Lee TQ (2013) Effect of posterior shoulder tightness on internal impingement in a cadaveric model of throwing. Knee Surg Sport Traumatol Arthrosc. doi:10.1007/s00167-013-2381-7

  21. Mihata T, Lee Y, McGarry MH, Abe M, Lee TQ (2004) Excessive humeral external rotation results in increased shoulder laxity. Am J Sports Med 32(5):1278–1285

    Article  PubMed  Google Scholar 

  22. Mologne TS, Zhao K, Hongo M, Romeo AA, An KN, Provencher MT (2008) The addition of rotator interval closure after arthroscopic repair of either anterior or posterior shoulder instability: effect on glenohumeral translation and range of motion. Am J Sports Med 36(6):1123–1131

    Article  PubMed  Google Scholar 

  23. Moon YL, Singh H, Yang H, Chul LK (2011) Arthroscopic rotator interval closure by purse string suture for symptomatic inferior shoulder instability. Orthopedics 34:4

    Google Scholar 

  24. Owens BD, Dawson L, Burks R, Cameron KL (2009) Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am 91(4):791–796

    Article  PubMed  Google Scholar 

  25. Paulson MM, Watnik NF, Dines DM (2000) Coracoid impingement syndrome, rotator interval reconstruction, and biceps tenodesis in the overhead athlete. Oper Tech Sport Med 8(4):268–275

    Article  Google Scholar 

  26. Peltier KE, McGarry MH, Tibone JE, Lee TQ (2012) Effects of combined anterior and posterior plication of the glenohumeral ligament complex for the repair of anterior glenohumeral instability: a biomechanical study. J Shoulder Elbow Surg 21(7):902–909

    Article  PubMed  Google Scholar 

  27. Pope EJ, Ward JP, Rokito AS (2011) Anterior shoulder instability: a history of arthroscopic treatment. Bull NYU Hosp Jt Dis 69(1):44–49

    PubMed  Google Scholar 

  28. Provencher MT, Mologne TS, Hongo M, Zhao K, Tasto JP, An K-N (2007) Arthroscopic versus open rotator interval closure: biomechanical evaluation of stability and motion. Arthroscopy 23(6):583–592

    Article  PubMed  Google Scholar 

  29. Reinold MM, Gill TJ (2010) Current concepts in the evaluation and treatment of the shoulder in overhead-throwing athletes, part 1: physical characteristics and clinical examination. Sports Health 2(1):39–50

    Article  PubMed Central  PubMed  Google Scholar 

  30. Reinold MM, Gill TJ, Wilk KE, Andrews JR (2010) Current concepts in the evaluation and treatment of the shoulder in overhead throwing athletes, part 2: injury prevention and treatment. Sports Health 2(2):101–115

    Article  PubMed Central  PubMed  Google Scholar 

  31. Remia LF, Ravalin RV, Lemly KS, McGarry MH, Kvitne RS, Lee TQ (2003) Biomechanical evaluation of multidirectional glenohumeral instability and repair. Clin Orthop Relat Res 416:225–236

    Article  PubMed  Google Scholar 

  32. Shafer BL, Mihata T, McGarry MH, Tibone JE, Lee TQ (2008) Effects of capsular plication and rotator interval closure in simulated multidirectional shoulder instability. J Bone Joint Surg Am 90(1):136–144

    Article  PubMed  Google Scholar 

  33. te Slaa RL, Wijffels MP, Brand R, Marti RK (2004) The prognosis following acute primary glenohumeral dislocation. J Bone Joint Surg Br 86(1):58–64

    Google Scholar 

  34. Thomas SJ, Swanik CB, Swanik K, Kelly JD (2013) Change in glenohumeral rotation and scapular position after a division I collegiate baseball season. J Sport Rehabil 22(2):115–121

    PubMed  Google Scholar 

  35. Thomas SJ, Swanik KA, Swanik C, Huxel KC, Kelly JD (2010) Change in glenohumeral rotation and scapular position after competitive high school baseball. J Sport Rehabil 19(2):125

    PubMed  Google Scholar 

  36. Tibone JE, McMahon PJ, Shrader TA, Sandusky MD, Lee TQ (1998) Glenohumeral joint translation after arthroscopic, nonablative, thermal capsuloplasty with a laser. Am J Sports Med 26(4):495–498

    CAS  PubMed  Google Scholar 

  37. Treacy SH, Field LD, Savoie FH (1997) Rotator interval capsule closure: an arthroscopic technique. Arthroscopy 13(1):103–106

    Article  CAS  PubMed  Google Scholar 

  38. Wichman MT, Snyder SJ (1997) Arthroscopic capsular plication for multidirectional instability of the shoulder. Oper Tech Sports Med 5(4):238–243

    Article  Google Scholar 

  39. Wolf EM, Eakin CL (1998) Arthroscopic capsular plication for posterior shoulder instability. Arthroscopy 14(2):153–163

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

VA Rehabilitation Research and Development Merit Review.

Author information

Authors and Affiliations

  1. Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street, Long Beach, CA, 90822, USA

    Jeffrey F. Sodl, Michelle H. McGarry, Sean T. Campbell & Thay Q. Lee

  2. Department of Orthopedic Surgery and Sports Medicine, University of Southern California, Los Angeles, CA, USA

    Jeffrey F. Sodl & James E. Tibone

  3. Department of Orthopaedic Surgery, University of California, Irvine, Irvine, CA, USA

    Thay Q. Lee

  4. Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, USA

    Thay Q. Lee

Authors
  1. Jeffrey F. Sodl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michelle H. McGarry
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean T. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James E. Tibone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thay Q. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thay Q. Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sodl, J.F., McGarry, M.H., Campbell, S.T. et al. Biomechanical effects of anterior capsular plication and rotator interval closure in simulated anterior shoulder instability. Knee Surg Sports Traumatol Arthrosc 24, 365–373 (2016). https://doi.org/10.1007/s00167-014-2878-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2878-8

Keywords

Search

Navigation