The Effect of Anterosuperior Rotator Cuff Tears on Glenohumeral Translation

doi:10.1016/j.arthro.2008.10.005

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 25, Issue 3, March 2009, Pages 282-289

https://doi.org/10.1016/j.arthro.2008.10.005 Get rights and content

Purpose

The purpose of this study was to sequentially investigate the biomechanical effects of anterosuperior rotator cuff tear size on superior and anterosuperior translation, including tears interrupting the anterior cable attachment and the anterior force couple.

Methods

Five cadaveric shoulders were subjected to different loading conditions in both the superior and anterosuperior directions in the intact state, with the supraspinatus cut and with sequentially larger anterosuperior rotator cuff tears.

Results

Isolated tears of the supraspinatus had no significant biomechanical consequences under any condition tested. Anterosuperior translation was greater than superior translation in the intact specimen and for every combination of anterosuperior rotator cuff defect. With the supraspinatus and the superior half of the subscapularis (i.e., the anterior cable attachment) released, there was no significant increase in anterosuperior or superior glenohumeral translation in response to lower loading conditions (10 to 20 N). At higher loading conditions (40 to 50 N), tears of the supraspinatus and superior half of the subscapularis led to significantly increased translation in both directions.

Conclusions

Simulated anterosuperior rotator cuff tears involving the superior half of the subscapularis significantly alter shoulder biomechanics and lead to increased anterosuperior and superior glenohumeral translation under higher loads. The anterior attachment of the rotator cuff cable is therefore an important determinant of the biomechanics of anterosuperior rotator cuff tears at higher loads but not at lower loads. Preserving the inferior half of the subscapularis was sufficient to maintain relatively normal shoulder kinematics under lower loading conditions. Tears of the entire subscapularis altered glenohumeral kinematics at essentially all loads.

Clinical Relevance

Knowledge of the biomechanics of anterosuperior rotator cuff tears enhances our understanding of how to best treat these lesions.

Section snippets

Methods

Five healthy fresh-frozen cadaveric glenohumeral joints were sectioned at the scapula from the thorax, with the humerus divided at its midshaft. There were 3 male and 2 female specimens, with a mean age of 73.4 years (range, 65 to 84 years). Each was visually inspected to ensure that the rotator cuff tendon and biceps tendon were intact and the articular cartilage and labrum were free from gross degenerative or traumatic changes. Specimens were stored at −20°C until the day before testing, when

Results

The force-displacement results are detailed in Table 1 and Fig 4. For all stages of tendon cutting and in all directions, there was a tendency for increasing translation as the load increased. For all loads tested, in both directions, there was a tendency for increasing translation for each stage of tendon cutting. For all loads, there was a significantly greater amount of translation in the anterosuperior direction than the superior direction for the intact specimen and for all stages of

Discussion

The main result of this study is that the cable is, in fact, an important determinant of the biomechanics of anterosuperior tears at higher loading conditions. Loss of the anterior cable attachment led to increased translation in both the anterosuperior and superior directions at these loads. At lower loading conditions, however, detachment of the anterior cable attachment, which occurred when the superior half of the subscapularis was released, did not produce a significant biomechanical

Conclusions

Acknowledgment

The authors thank Philip C. Noble, Ph.D., for his help with statistical analysis.

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: The authors report no conflict of interest.

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Original ArticleThe Effect of Anterosuperior Rotator Cuff Tears on Glenohumeral Translation

Purpose

Methods

Results

Conclusions

Clinical Relevance

Section snippets

Methods

Results

Discussion

Conclusions

Acknowledgment

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Debridement of partial-thickness tears of the rotator cuff without acromioplasty: Long-term follow-up and review of the literature

J Bone Joint Surg Am

Superior humeral dislocation

Clin Orthop Relat Res

Dynamic glenohumeral stability provided by three heads of the deltoid muscle

Clin Orthop Relat Res

Original Article
The Effect of Anterosuperior Rotator Cuff Tears on Glenohumeral Translation