Superior Capsular Reconstruction Partially Restores Native Glenohumeral Joint Loads in a Dynamic Biomechanical Shoulder Model.

Muench, Lukas N; Dyrna, Felix; Otto, Alexander; Wellington, Ian; Obopilwe, Elifho; Scheiderer, Bastian; Imhoff, Andreas B; Beitzel, Knut; Mazzocca, Augustus D; Berthold, Daniel P

doi:10.1016/j.arthro.2023.02.019

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2023

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Title:: Superior Capsular Reconstruction Partially Restores Native Glenohumeral Joint Loads in a Dynamic Biomechanical Shoulder Model.
Document type:: Article; Journal Article
Author(s):: Muench, Lukas N; Dyrna, Felix; Otto, Alexander; Wellington, Ian; Obopilwe, Elifho; Scheiderer, Bastian; Imhoff, Andreas B; Beitzel, Knut; Mazzocca, Augustus D; Berthold, Daniel P
Abstract:: PURPOSE: To evaluate the effect of an irreparable posterosuperior rotator cuff tear (PSRCT) on glenohumeral joint loads and to quantify improvement after superior capsular reconstruction (SCR) using an acellular dermal allograft. METHODS: Ten fresh-frozen cadaveric shoulders were tested using a validated dynamic shoulder simulator. A pressure mapping sensor was placed between the humeral head and glenoid surface. Each specimen underwent the following conditions: (1) native, (2) irreparable PSRCT, and (3) SCR using a 3-mm-thick acellular dermal allograft. Glenohumeral abduction angle (gAA) and superior humeral head migration (SM) were measured using 3-dimensional motion-tracking software. Cumulative deltoid force (cDF) and glenohumeral contact mechanics, including glenohumeral contact area and glenohumeral contact pressure (gCP), were assessed at rest, 15°, 30°, 45°, and maximum angle of glenohumeral abduction. RESULTS: The PSRCT resulted in a significant decrease of gAA along with an increase in SM, cDF, and gCP (P < .001, respectively). SCR did not restore native gAA (P < .001); however, SM was significantly reduced (P < .001). Further, SCR significantly reduced deltoid forces at 30° (P = .007) and 45° of abduction (P = .007) when compared with the PSRCT. SCR did not restore native cDF at 30° (P = .015), 45° (P < .001), and maximum angle (P < .001) of glenohumeral abduction. Compared with the PSRCT, SCR resulted in a significant decrease of gCP at 15° (P = .008), 30° (P = .002), and 45° (P = .006). However, SCR did not completely restore native gCP at 45° (P = .038) and maximum abduction angle (P = .014). CONCLUSIONS: In this dynamic shoulder model, SCR only partially restored native glenohumeral joint loads. However, SCR significantly decreased glenohumeral contact pressure, cumulative deltoid forces, and superior migration, while increasing abduction motion, when compared with the posterosuperior rotator cuff tear. CLINICAL RELEVANCE: These observations raise concerns regarding the true joint-preserving potential of SCR for an irreparable posterosuperior rotator cuff tear, along with its ability to delay progression of cuff tear arthropathy and eventual conversion to reverse shoulder arthroplasty.
Journal title abbreviation:: Arthroscopy
Year:: 2023
Journal volume:: 39
Journal issue:: 8
Pages contribution:: 1781-1789
Fulltext / DOI:: doi:10.1016/j.arthro.2023.02.019
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/36868531
Print-ISSN:: 0749-8063
TUM Institution:: Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)2023