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Scientific Articles   |    
Effects of Capsular Plication and Rotator Interval Closure in Simulated Multidirectional Shoulder Instability
Brian L. Shafer, MD1; Teruhisa Mihata, MD, PhD2; Michelle H. McGarry, MS3; James E. Tibone, MD1; Thay Q. Lee, PhD3
1 University of Southern California, Orthopaedic Surgery Associates, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033
2 Department of Orthopaedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686 Japan
3 Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, 5901 East 7th Street (09/151), Long Beach, CA 90822. E-mail address for T.Q. Lee: tqlee@med.va.gov
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Department of Veterans Affairs Rehabilitation Research and Development Service and Merit Review. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Jan 01;90(1):136-144. doi: 10.2106/JBJS.F.00841
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Abstract

Background: Arthroscopic treatment of multidirectional shoulder instability with use of capsular plication and rotator interval closure has been shown to be effective in several clinical studies; however, the biomechanical effects of these procedures have not been elucidated. The purpose of this study was to assess biomechanically the effect of arthroscopic capsular plication combined with rotator interval closure on rotational range of motion, humeral head position throughout rotation, and glenohumeral translation.

Methods: Seven cadaveric shoulders were stretched to 10% beyond the maximum range of motion in 60° and 0° of glenohumeral abduction. Testing was performed for the intact and stretched conditions and following three sequential capsular repairs: anterior plication, posterior plication, and rotator interval closure. Rotational range of motion, humeral head position throughout the range of motion, and glenohumeral translations were measured in both positions.

Results: Stretching increased the total rotational range of motion in 60° and 0° of abduction. After anterior plication alone, total rotation decreased significantly (p < 0.05) in both positions and was restored to the intact state. Total translation with a 20-N load increased significantly in the 60° of abduction position after stretching (p = 0.03). Anterior-posterior translation decreased significantly compared with the stretched state only after all components of the repair were completed in 60° of abduction (p = 0.0003 with a 15-N load and p = 0.0001 with a 20-N load). This decrease was also found to be significantly less than the intact condition (p = 0.008 with a 15-N load and p = 0.001 with a 20-N load). A similar trend in results was found with superior-inferior translations in the 0° of abduction position.

Conclusions: Capsular plication alone reduces range of motion to the intact state. Reductions in translation, however, may require the addition of rotator interval closure. Changes in translation and rotation after repair are dependent on arm position. In some positions, the addition of rotator interval closure may also result in overtightening.

Clinical Relevance: To avoid overtightening in the treatment of multidirectional instability with arthroscopic capsular plication combined with rotator interval closure, each patient should be evaluated individually to determine if the rotator interval closure is needed.

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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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