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Arthroscopic Anteroinferior Suture Plication Resulting in Decreased Glenohumeral Translation and External RotationStudy of A Cadaver Model
Frank G. Alberta, MD1; Neal S. ElAttrache, MD2; Teruhisa Mihata, MD, PhD3; Michelle H. McGarry, MS3; James E. Tibone, MD4; Thay Q Lee, PhD3
1 Active Orthopaedics and Sports Medicine, PA, 390 Old Hook Road, Westwood, NJ 07675. E-mail address: dralberta@activeorthopedic.com
2 Kerlan-Jobe Orthopaedic Clinic Westchester, 6801 Park Terrace Drive, Los Angeles, CA 90045
3 Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151) and University of California, Irvine, 5901 East 7th Street, Long Beach, CA 90822. E-mail address for T.Q. Lee: tqlee@med.va.gov
4 Department of Orthopaedic Surgery, University of Southern California, 1520 San Pablo Street, Los Angeles, CA 90033. E-mail address: tibone@usc.edu
View Disclosures and Other Information
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Arthrex, Incorporated, Naples, Florida (Arthrex supported this research in the form of donation of cadaveric specimens and arthroscopic equipment), the Department of Veterans Affairs, and the John C. Griswold Foundation. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (consulting fees provided by Arthrex). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, California

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Jan 01;88(1):179-187. doi: 10.2106/JBJS.D.02974
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Background: The consequences of arthroscopic plication for the treatment of anterior shoulder instability are unknown. The purpose of this study was to evaluate the effects of arthroscopic plication on glenohumeral translation, the rotational range of motion, and the positions of the glenohumeral center of rotation.

Methods: Six cadaver shoulders were tested in the intact state, after simulation of anterior instability by anterior capsular stretching, after creation of arthroscopic portals, and following a 10-mm anteroinferior arthroscopic suture plication. Capsulolabral build-up was measured to quantify the increase after plication.

Results: Stretching resulted in a significant increase, compared with the intact state, in external rotation (mean increase, 23.2° [14.3%]; p < 0.001) but not in glenohumeral translation (mean increase, 0.8 mm [7.4%] under a 20-N translational load; p = 0.06). After plication, external rotation decreased significantly (by 12.6° [6.7%], p = 0.003) compared with that following the stretching. After plication, the glenohumeral center of rotation was significantly shifted posteriorly at 60°, 90°, and 120° of external rotation and inferiorly at 90° and 120°. Plication also resulted in significant decreases in anterior translation (mean decrease, 61.1% under a 15-N translational load and 49.8% under a 20-N translational load; p < 0.001), posterior translation (mean decrease, 11.4% under a 15-N translational load and 13.1% under a 20-N translational load; p = 0.002 and p < 0.001, respectively), and inferior translation (mean decrease, 3.2% under a 20-N load; p = 0.04). The height of the capsulolabral "bumper" increased from 2.9 mm in the intact state to 6.4 mm following plication (p = 0.001).

Conclusions: Arthroscopic anteroinferior plication effectively reduces anterior translation and external rotation. Capsulolabral buildup may help limit anterior translation without affecting rotation. Plication resulted in a shift of the glenohumeral center of rotation posteriorly and inferiorly.

Clinical Relevance: Anterior translation and external rotation can be significantly restricted by arthroscopic anteroinferior suture plication.

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    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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