Arthroscopic Versus Open Rotator Interval Closure: Biomechanical Evaluation of Stability and Motion

Matthew T. Provencher, Timothy S. Mologne, Michio Hongo, Kristin D Zhao, James P. Tasto, Kai Nan An

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Purpose: The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder. Methods: Fourteen fresh-frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90° abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90° abduction with external rotation; and (4) posterior translation at 90° flexion with internal rotation. Results: Posterior stability was not improved from the intact state by either open (1.0-mm change) or arthroscopic (0.1-mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90° abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8°) versus the arthroscopic group (24.4°, P = .0038). The arthroscopic group showed an 11.7° loss of ER in 90° abduction (P= .018) versus the open group loss of 4.8°. There were no significant differences in loss of IR in either neutral or 90° abduction. Conclusions: Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques. Clinical Relevance: This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.

Original languageEnglish (US)
Pages (from-to)583-592
Number of pages10
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume23
Issue number6
DOIs
StatePublished - Jun 2007

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Articular Range of Motion
Shoulder Joint
Ontario
Canada

Keywords

  • Anterior instability
  • Multidirectional instability
  • Plication
  • Posterior instability
  • Rotator interval
  • Shoulder
  • Shoulder instability

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Arthroscopic Versus Open Rotator Interval Closure : Biomechanical Evaluation of Stability and Motion. / Provencher, Matthew T.; Mologne, Timothy S.; Hongo, Michio; Zhao, Kristin D; Tasto, James P.; An, Kai Nan.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 23, No. 6, 06.2007, p. 583-592.

Research output: Contribution to journalArticle

Provencher, Matthew T. ; Mologne, Timothy S. ; Hongo, Michio ; Zhao, Kristin D ; Tasto, James P. ; An, Kai Nan. / Arthroscopic Versus Open Rotator Interval Closure : Biomechanical Evaluation of Stability and Motion. In: Arthroscopy - Journal of Arthroscopic and Related Surgery. 2007 ; Vol. 23, No. 6. pp. 583-592.
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abstract = "Purpose: The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder. Methods: Fourteen fresh-frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90° abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90° abduction with external rotation; and (4) posterior translation at 90° flexion with internal rotation. Results: Posterior stability was not improved from the intact state by either open (1.0-mm change) or arthroscopic (0.1-mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90° abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8°) versus the arthroscopic group (24.4°, P = .0038). The arthroscopic group showed an 11.7° loss of ER in 90° abduction (P= .018) versus the open group loss of 4.8°. There were no significant differences in loss of IR in either neutral or 90° abduction. Conclusions: Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques. Clinical Relevance: This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.",
keywords = "Anterior instability, Multidirectional instability, Plication, Posterior instability, Rotator interval, Shoulder, Shoulder instability",
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T1 - Arthroscopic Versus Open Rotator Interval Closure

T2 - Biomechanical Evaluation of Stability and Motion

AU - Provencher, Matthew T.

AU - Mologne, Timothy S.

AU - Hongo, Michio

AU - Zhao, Kristin D

AU - Tasto, James P.

AU - An, Kai Nan

PY - 2007/6

Y1 - 2007/6

N2 - Purpose: The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder. Methods: Fourteen fresh-frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90° abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90° abduction with external rotation; and (4) posterior translation at 90° flexion with internal rotation. Results: Posterior stability was not improved from the intact state by either open (1.0-mm change) or arthroscopic (0.1-mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90° abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8°) versus the arthroscopic group (24.4°, P = .0038). The arthroscopic group showed an 11.7° loss of ER in 90° abduction (P= .018) versus the open group loss of 4.8°. There were no significant differences in loss of IR in either neutral or 90° abduction. Conclusions: Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques. Clinical Relevance: This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.

AB - Purpose: The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder. Methods: Fourteen fresh-frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90° abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90° abduction with external rotation; and (4) posterior translation at 90° flexion with internal rotation. Results: Posterior stability was not improved from the intact state by either open (1.0-mm change) or arthroscopic (0.1-mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90° abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8°) versus the arthroscopic group (24.4°, P = .0038). The arthroscopic group showed an 11.7° loss of ER in 90° abduction (P= .018) versus the open group loss of 4.8°. There were no significant differences in loss of IR in either neutral or 90° abduction. Conclusions: Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques. Clinical Relevance: This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.

KW - Anterior instability

KW - Multidirectional instability

KW - Plication

KW - Posterior instability

KW - Rotator interval

KW - Shoulder

KW - Shoulder instability

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