Restoration of Shoulder Biomechanics According to Degree of Repair Completion in a Cadaveric Model of Massive Rotator Cuff Tear: Importance of Margin Convergence and Posterior Cuff Fixation
Background: Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohu...
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| Veröffentlicht in: | The American journal of sports medicine 2012-11, Vol.40 (11), p.2448-2453 |
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| creator | Oh, Joo Han McGarry, Michelle H. Jun, Bong Jae Gupta, Akash Chung, Kyung Chil Hwang, James Lee, Thay Q. |
| description | Background:
Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohumeral kinematics, and gap formation at the repaired tendon edge following massive cuff tear and repair according to the degree of repair completion.
Hypothesis:
Posterior fixation will restore the altered biomechanics of massive rotator cuff tear.
Study Design:
Controlled laboratory study.
Methods:
Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane. Muscle loading was applied based on physiological muscle cross-sectional area ratios. Maximum internal (MaxIR) and external rotations (MaxER) were measured. Humeral head apex (HHA) position and gap formation at the repaired tendon edge were measured using a MicroScribe from MaxIR to MaxER in 30° increments. Testing was performed for intact, massive cuff tear, complete repair, and 4 types of partial repair. A repeated-measures analysis of variance was used to determine significant differences.
Results:
Massive tear significantly increased ROM and shifted HHA superiorly in MaxIR at all abduction angles (P < .05). The complete repair restored ROM to intact (P < .05), while all partial repairs did not. Abnormal HHA elevation due to massive tear was restored by all repairs (P < .05). Release of the anterior single row alone and release of the marginal convergence significantly increased gap formation at the anterior tendon edge (P < .05).
Conclusion:
This study emphasizes the importance of anterior fixation in massive cuff tear to restore rotational range of motion and decrease gap formation at the repaired tendon edge and of posterior fixation to restore abnormal glenohumeral kinematics due to massive cuff tear.
Clinical Relevance:
If complete repair of massive cuff tear is not possible, posterior cuff (infraspinatus) repair is necessary to restore abnormal glenohumeral kinematics, and margin convergence anteriorly is recommended to decrease gap formation of the repaired tendon edge, which may provide a better biomechanical environment for healing. |
| doi_str_mv | 10.1177/0363546512458775 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1126577374</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546512458775</sage_id><sourcerecordid>2810436921</sourcerecordid><originalsourceid>FETCH-LOGICAL-c348t-c810cedb25798b74d261026ec540a008e7ba35b4b5640112eba7f9ca085458733</originalsourceid><addsrcrecordid>eNp1kc1v1DAQxS0EokvhzglZQkhcAv52ciyBAlIrpKWco4kz2bpK4sVOKnHiX8fpLh-qxMmH-b03b_wIec7ZG86tfcukkVoZzYXSpbX6AdlwrUUhpdEPyWYdF-v8hDxJ6YYxxq0pH5MTIapScVFtyM8tpjlEmH2YaOjp1-uwDB1G-s6HEd01TN4leuZciJ2fdnQO9D3uIuIKb3EPPtI6jPsB7xz8RIHW0MEtRu_oZehwWMlLSMnfIt2GGfI6Wi99T68Q4lPyqIch4bPje0q-nX-4qj8VF18-fq7PLgonVTkXruTMYdcKbauytaoThjNh0GnFgLESbQtSt6rVRjHOBbZg-8oBK_X6M1KektcH330M35d8czP65HAYYMKwpCZrjLZWWpXRl_fQm7DEKafLlBJlJZXQmWIHysWQUsS-2Uc_QvzRcNas5TT3y8mSF0fjpR2x-yP43UYGXh0BSA6GPsLkfPrLGWMqXq0JiwOXYIf_pPvf4l9ohqI0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1142893425</pqid></control><display><type>article</type><title>Restoration of Shoulder Biomechanics According to Degree of Repair Completion in a Cadaveric Model of Massive Rotator Cuff Tear: Importance of Margin Convergence and Posterior Cuff Fixation</title><source>Access via SAGE</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Oh, Joo Han ; McGarry, Michelle H. ; Jun, Bong Jae ; Gupta, Akash ; Chung, Kyung Chil ; Hwang, James ; Lee, Thay Q.</creator><creatorcontrib>Oh, Joo Han ; McGarry, Michelle H. ; Jun, Bong Jae ; Gupta, Akash ; Chung, Kyung Chil ; Hwang, James ; Lee, Thay Q.</creatorcontrib><description>Background:
Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohumeral kinematics, and gap formation at the repaired tendon edge following massive cuff tear and repair according to the degree of repair completion.
Hypothesis:
Posterior fixation will restore the altered biomechanics of massive rotator cuff tear.
Study Design:
Controlled laboratory study.
Methods:
Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane. Muscle loading was applied based on physiological muscle cross-sectional area ratios. Maximum internal (MaxIR) and external rotations (MaxER) were measured. Humeral head apex (HHA) position and gap formation at the repaired tendon edge were measured using a MicroScribe from MaxIR to MaxER in 30° increments. Testing was performed for intact, massive cuff tear, complete repair, and 4 types of partial repair. A repeated-measures analysis of variance was used to determine significant differences.
Results:
Massive tear significantly increased ROM and shifted HHA superiorly in MaxIR at all abduction angles (P < .05). The complete repair restored ROM to intact (P < .05), while all partial repairs did not. Abnormal HHA elevation due to massive tear was restored by all repairs (P < .05). Release of the anterior single row alone and release of the marginal convergence significantly increased gap formation at the anterior tendon edge (P < .05).
Conclusion:
This study emphasizes the importance of anterior fixation in massive cuff tear to restore rotational range of motion and decrease gap formation at the repaired tendon edge and of posterior fixation to restore abnormal glenohumeral kinematics due to massive cuff tear.
Clinical Relevance:
If complete repair of massive cuff tear is not possible, posterior cuff (infraspinatus) repair is necessary to restore abnormal glenohumeral kinematics, and margin convergence anteriorly is recommended to decrease gap formation of the repaired tendon edge, which may provide a better biomechanical environment for healing.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546512458775</identifier><identifier>PMID: 22984129</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Biomechanical Phenomena ; Biomechanics ; Biomechanics. Biorheology ; Cadaver ; Comparative studies ; Diseases of the osteoarticular system ; Female ; Fundamental and applied biological sciences. Psychology ; Humans ; Injuries of the limb. Injuries of the spine ; Juxtaarticular diseases. Extraarticular rhumatism ; Kinematics ; Male ; Medical sciences ; Middle Aged ; Physiology ; Range of Motion, Articular ; Rotator Cuff - physiopathology ; Rotator Cuff - surgery ; Rotator Cuff Injuries ; Shoulder ; Shoulder - physiopathology ; Shoulder - surgery ; Tissues, organs and organisms biophysics ; Traumas. Diseases due to physical agents ; Wound healing</subject><ispartof>The American journal of sports medicine, 2012-11, Vol.40 (11), p.2448-2453</ispartof><rights>2012 The Author(s)</rights><rights>2014 INIST-CNRS</rights><rights>Copyright Sage Publications Ltd. Nov 2012</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c348t-c810cedb25798b74d261026ec540a008e7ba35b4b5640112eba7f9ca085458733</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546512458775$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546512458775$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26669194$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22984129$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oh, Joo Han</creatorcontrib><creatorcontrib>McGarry, Michelle H.</creatorcontrib><creatorcontrib>Jun, Bong Jae</creatorcontrib><creatorcontrib>Gupta, Akash</creatorcontrib><creatorcontrib>Chung, Kyung Chil</creatorcontrib><creatorcontrib>Hwang, James</creatorcontrib><creatorcontrib>Lee, Thay Q.</creatorcontrib><title>Restoration of Shoulder Biomechanics According to Degree of Repair Completion in a Cadaveric Model of Massive Rotator Cuff Tear: Importance of Margin Convergence and Posterior Cuff Fixation</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohumeral kinematics, and gap formation at the repaired tendon edge following massive cuff tear and repair according to the degree of repair completion.
Hypothesis:
Posterior fixation will restore the altered biomechanics of massive rotator cuff tear.
Study Design:
Controlled laboratory study.
Methods:
Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane. Muscle loading was applied based on physiological muscle cross-sectional area ratios. Maximum internal (MaxIR) and external rotations (MaxER) were measured. Humeral head apex (HHA) position and gap formation at the repaired tendon edge were measured using a MicroScribe from MaxIR to MaxER in 30° increments. Testing was performed for intact, massive cuff tear, complete repair, and 4 types of partial repair. A repeated-measures analysis of variance was used to determine significant differences.
Results:
Massive tear significantly increased ROM and shifted HHA superiorly in MaxIR at all abduction angles (P < .05). The complete repair restored ROM to intact (P < .05), while all partial repairs did not. Abnormal HHA elevation due to massive tear was restored by all repairs (P < .05). Release of the anterior single row alone and release of the marginal convergence significantly increased gap formation at the anterior tendon edge (P < .05).
Conclusion:
This study emphasizes the importance of anterior fixation in massive cuff tear to restore rotational range of motion and decrease gap formation at the repaired tendon edge and of posterior fixation to restore abnormal glenohumeral kinematics due to massive cuff tear.
Clinical Relevance:
If complete repair of massive cuff tear is not possible, posterior cuff (infraspinatus) repair is necessary to restore abnormal glenohumeral kinematics, and margin convergence anteriorly is recommended to decrease gap formation of the repaired tendon edge, which may provide a better biomechanical environment for healing.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Biomechanical Phenomena</subject><subject>Biomechanics</subject><subject>Biomechanics. Biorheology</subject><subject>Cadaver</subject><subject>Comparative studies</subject><subject>Diseases of the osteoarticular system</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Humans</subject><subject>Injuries of the limb. Injuries of the spine</subject><subject>Juxtaarticular diseases. Extraarticular rhumatism</subject><subject>Kinematics</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Physiology</subject><subject>Range of Motion, Articular</subject><subject>Rotator Cuff - physiopathology</subject><subject>Rotator Cuff - surgery</subject><subject>Rotator Cuff Injuries</subject><subject>Shoulder</subject><subject>Shoulder - physiopathology</subject><subject>Shoulder - surgery</subject><subject>Tissues, organs and organisms biophysics</subject><subject>Traumas. Diseases due to physical agents</subject><subject>Wound healing</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1v1DAQxS0EokvhzglZQkhcAv52ciyBAlIrpKWco4kz2bpK4sVOKnHiX8fpLh-qxMmH-b03b_wIec7ZG86tfcukkVoZzYXSpbX6AdlwrUUhpdEPyWYdF-v8hDxJ6YYxxq0pH5MTIapScVFtyM8tpjlEmH2YaOjp1-uwDB1G-s6HEd01TN4leuZciJ2fdnQO9D3uIuIKb3EPPtI6jPsB7xz8RIHW0MEtRu_oZehwWMlLSMnfIt2GGfI6Wi99T68Q4lPyqIch4bPje0q-nX-4qj8VF18-fq7PLgonVTkXruTMYdcKbauytaoThjNh0GnFgLESbQtSt6rVRjHOBbZg-8oBK_X6M1KektcH330M35d8czP65HAYYMKwpCZrjLZWWpXRl_fQm7DEKafLlBJlJZXQmWIHysWQUsS-2Uc_QvzRcNas5TT3y8mSF0fjpR2x-yP43UYGXh0BSA6GPsLkfPrLGWMqXq0JiwOXYIf_pPvf4l9ohqI0</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>Oh, Joo Han</creator><creator>McGarry, Michelle H.</creator><creator>Jun, Bong Jae</creator><creator>Gupta, Akash</creator><creator>Chung, Kyung Chil</creator><creator>Hwang, James</creator><creator>Lee, Thay Q.</creator><general>SAGE Publications</general><general>Sage Publications</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20121101</creationdate><title>Restoration of Shoulder Biomechanics According to Degree of Repair Completion in a Cadaveric Model of Massive Rotator Cuff Tear</title><author>Oh, Joo Han ; McGarry, Michelle H. ; Jun, Bong Jae ; Gupta, Akash ; Chung, Kyung Chil ; Hwang, James ; Lee, Thay Q.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-c810cedb25798b74d261026ec540a008e7ba35b4b5640112eba7f9ca085458733</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Biomechanical Phenomena</topic><topic>Biomechanics</topic><topic>Biomechanics. Biorheology</topic><topic>Cadaver</topic><topic>Comparative studies</topic><topic>Diseases of the osteoarticular system</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Humans</topic><topic>Injuries of the limb. Injuries of the spine</topic><topic>Juxtaarticular diseases. Extraarticular rhumatism</topic><topic>Kinematics</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Physiology</topic><topic>Range of Motion, Articular</topic><topic>Rotator Cuff - physiopathology</topic><topic>Rotator Cuff - surgery</topic><topic>Rotator Cuff Injuries</topic><topic>Shoulder</topic><topic>Shoulder - physiopathology</topic><topic>Shoulder - surgery</topic><topic>Tissues, organs and organisms biophysics</topic><topic>Traumas. Diseases due to physical agents</topic><topic>Wound healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oh, Joo Han</creatorcontrib><creatorcontrib>McGarry, Michelle H.</creatorcontrib><creatorcontrib>Jun, Bong Jae</creatorcontrib><creatorcontrib>Gupta, Akash</creatorcontrib><creatorcontrib>Chung, Kyung Chil</creatorcontrib><creatorcontrib>Hwang, James</creatorcontrib><creatorcontrib>Lee, Thay Q.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oh, Joo Han</au><au>McGarry, Michelle H.</au><au>Jun, Bong Jae</au><au>Gupta, Akash</au><au>Chung, Kyung Chil</au><au>Hwang, James</au><au>Lee, Thay Q.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Restoration of Shoulder Biomechanics According to Degree of Repair Completion in a Cadaveric Model of Massive Rotator Cuff Tear: Importance of Margin Convergence and Posterior Cuff Fixation</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>40</volume><issue>11</issue><spage>2448</spage><epage>2453</epage><pages>2448-2453</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>Background:
Complete repair in massive rotator cuff tear may not be possible, allowing for only partial repair. However, the effect of partial repair on glenohumeral biomechanics has not been evaluated. Therefore, the purpose of this study was to compare the rotational range of motion (ROM), glenohumeral kinematics, and gap formation at the repaired tendon edge following massive cuff tear and repair according to the degree of repair completion.
Hypothesis:
Posterior fixation will restore the altered biomechanics of massive rotator cuff tear.
Study Design:
Controlled laboratory study.
Methods:
Eight cadaveric shoulders were tested at 0°, 30°, and 60° of abduction in the scapular plane. Muscle loading was applied based on physiological muscle cross-sectional area ratios. Maximum internal (MaxIR) and external rotations (MaxER) were measured. Humeral head apex (HHA) position and gap formation at the repaired tendon edge were measured using a MicroScribe from MaxIR to MaxER in 30° increments. Testing was performed for intact, massive cuff tear, complete repair, and 4 types of partial repair. A repeated-measures analysis of variance was used to determine significant differences.
Results:
Massive tear significantly increased ROM and shifted HHA superiorly in MaxIR at all abduction angles (P < .05). The complete repair restored ROM to intact (P < .05), while all partial repairs did not. Abnormal HHA elevation due to massive tear was restored by all repairs (P < .05). Release of the anterior single row alone and release of the marginal convergence significantly increased gap formation at the anterior tendon edge (P < .05).
Conclusion:
This study emphasizes the importance of anterior fixation in massive cuff tear to restore rotational range of motion and decrease gap formation at the repaired tendon edge and of posterior fixation to restore abnormal glenohumeral kinematics due to massive cuff tear.
Clinical Relevance:
If complete repair of massive cuff tear is not possible, posterior cuff (infraspinatus) repair is necessary to restore abnormal glenohumeral kinematics, and margin convergence anteriorly is recommended to decrease gap formation of the repaired tendon edge, which may provide a better biomechanical environment for healing.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>22984129</pmid><doi>10.1177/0363546512458775</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Biological and medical sciences Biomechanical Phenomena Biomechanics Biomechanics. Biorheology Cadaver Comparative studies Diseases of the osteoarticular system Female Fundamental and applied biological sciences. Psychology Humans Injuries of the limb. Injuries of the spine Juxtaarticular diseases. Extraarticular rhumatism Kinematics Male Medical sciences Middle Aged Physiology Range of Motion, Articular Rotator Cuff - physiopathology Rotator Cuff - surgery Rotator Cuff Injuries Shoulder Shoulder - physiopathology Shoulder - surgery Tissues, organs and organisms biophysics Traumas. Diseases due to physical agents Wound healing |
| title | Restoration of Shoulder Biomechanics According to Degree of Repair Completion in a Cadaveric Model of Massive Rotator Cuff Tear: Importance of Margin Convergence and Posterior Cuff Fixation |
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