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Comparison of Glenohumeral Mechanics Following a Capsular Shift and Anterior Tightening
Vincent M. Wang, PhD1; Matthew T. Sugalski, MD2; William N. Levine, MD2; Robert J. Pawluk, MS2; Van C. Mow, PhD3; Louis U. Bigliani, MD2
1 Leni and Peter W. May Department of Orthopaedics, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1188, New York, NY 10029-6574
2 Department of Orthopaedic Surgery, Columbia-Presbyterian Medical Center, 622 West 168th Street, PH11-Center, New York, NY 10032. E-mail address for L.U. Bigliani: lub1@columbia.edu
3 Department of Biomedical Engineering, Columbia University, 351C Engineering Terrace, 1210 Amsterdam Avenue, MC 8904, New York, NY 10027
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Investigation performed at Columbia University, New York, NY

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1312-1322. doi: 10.2106/JBJS.C.01031
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Abstract

Background: Numerous surgical techniques have been developed to treat glenohumeral instability. Anterior tightening procedures have been associated with secondary glenohumeral osteoarthritis, unlike the anterior-inferior capsular shift procedure, which has been widely advocated as a more anatomical repair. The objective of the present study was to quantify glenohumeral joint translations, articular contact, and resultant forces in cadaveric specimens in order to compare the effects of unidirectional anterior tightening with those of the anterior-inferior capsular shift.

Methods: Six normal fresh-frozen cadaveric shoulders were tested on a custom rig with use of a coordinate-measuring machine to obtain kinematic measurements and a six-axis load transducer to measure resultant external joint forces. Shoulders were tested in the scapular plane in three configurations (normal anatomical, anterior tightening, and anterior-inferior capsular shift) and in three humeral rotations (neutral, internal, and external). Glenohumeral articular surface geometry was quantified with use of stereophotogrammetry for kinematic and contact analyses. Resultant joint forces were computed on the basis of digitized coordinates of tendon insertions and origins.

Results: Compared with the controls (maximum elevation, 167° ± 8°), the anteriorly tightened specimens demonstrated loss of external rotation, significantly restricted maximum elevation (135° ± 16°, p = 0.002), posterior-inferior humeral head subluxation, and significantly greater posteriorly directed resultant forces at higher elevations (p < 0.05). In contrast, compared with the controls, the specimens that had been treated with the anterior-inferior capsular shift demonstrated a similar maximum elevation (159° ± 11°, p = 0.8) without any apparent loss of external rotation and with reduced humeral translation.

Conclusions: Anterior tightening adversely affects joint mechanics by decreasing joint stability, limiting both external rotation and arm elevation, and requiring greater posterior joint forces to attain maximum elevation. The anterior-inferior capsular shift improves joint stability while preserving external rotation with no significant loss of maximum elevation.

Clinical Relevance: The results of this in vitro cadaveric study support clinical observations that the anterior-inferior capsular shift procedure more closely recreates normal joint mechanics in comparison with unidirectional anterior tightening procedures.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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