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Park J, Kim DS, Huh H, Cho WG, Kim H, Lee DW. In Vivo 3-Dimensional Dynamic Evaluation of Shoulder Kinematics After the Latarjet Procedure: Comparison With the Contralateral Healthy Shoulder. Orthop J Sports Med 2024; 12:23259671241226909. [PMID: 38486807 PMCID: PMC10938626 DOI: 10.1177/23259671241226909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/18/2023] [Indexed: 03/17/2024] Open
Abstract
Background Researchers have attempted to understand the underlying mechanism of the Latarjet procedure; however, its effects on shoulder kinematics have not been well studied. Purpose/Hypothesis The purpose was to analyze shoulder kinematics after the Latarjet procedure. It was hypothesized that the nonanatomic transfer of the coracoid process during the procedure would affect normal shoulder kinematics. Study Design Controlled laboratory study. Methods The study included 10 patients (age range, 20-52 years) who underwent the modified Latarjet procedure between June 2016 and November 2021. Computed tomography and fluoroscopy were conducted on both shoulder joints of all patients, and 3-dimensional models were reconstructed. The 3-dimensional coordinates were encoded on the reconstructed models, and shoulder kinematics were analyzed through a 3-dimensional-2-dimensional model-image registration technique. Scapular rotation parameters (scapular upward rotation, posterior tilt, external rotation, and scapulohumeral rhythm) were compared between the Latarjet and the nonsurgical contralateral sides during humeral abduction, as was anteroposterior (AP) translation relative to the glenoid center during active humeral external rotation. Results The Latarjet side displayed significantly higher values of scapular upward rotation at higher degrees of humeral elevation (130°, 140°, and 150°) compared with the nonsurgical side (P = .027). Posterior tilt, external rotation, and scapulohumeral rhythm were not significantly different between sides. AP translation at maximal humeral rotation was not significantly different between sides (Latarjet, -0.06 ± 5.73 mm vs nonsurgical, 5.33 ± 1.60 mm; P = .28). Interestingly, on the Latarjet side, AP translation increased until 40° of humeral rotation (4.27 ± 4.64 mm) but began to decrease from 50° of humeral rotation. Conclusion The Latarjet side demonstrated significant changes in scapular upward rotation during higher degrees of humeral elevation compared with the contralateral shoulder. Posterior movement of the humeral head at >50° of humeral rotation could be the desired effect of anterior stabilization; however, researchers should evaluate long-term complications such as osteoarthritis. Clinical Relevance Analysis of shoulder kinematics after the Latarjet procedure could provide information regarding long-term outcomes and whether the procedure would affect the daily activities of patients.
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Affiliation(s)
- Jisu Park
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Doo Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Hyungkyu Huh
- Daegu-Gyeongbuk Medical Innovation Foundation, Dae-gu, Republic of Korea
| | - Won Gil Cho
- Department of Anatomy, Wonju College of Medicine, Yonsei University, Gangwon-do, Republic of Korea
| | - HyunWoo Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Republic of Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, Seoul, Republic of Korea
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Zhang F, Liao W, Chen X, Zhang B, Xu L, Wang X, Zhu Y, Fu Y, Xiong W, Song S, Sheng X, Gao H, Lai S, Zhang Q. Stabilizing Mechanisms in Patients Treated Using Hill-Sachs Remplissage With Bankart Repair in Abduction-External Rotation Position. Am J Sports Med 2024; 52:603-612. [PMID: 38288525 DOI: 10.1177/03635465231220373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Hill-Sachs lesion (HSL) remplissage with Bankart repair (RMBR) provides a minimally invasive solution for treating HSLs and glenoid bone defects of <25%. The infraspinatus tendon is inserted into the HSL during the remplissage process, causing the infraspinatus to shift medially, leading to an unknown effect on glenohumeral alignment during the resting abduction-external rotation (ABER) and muscle-active states. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate the possible check-rein effect and muscle-active control in stabilizing the glenohumeral joint after RMBR in vivo. We hypothesized that the check-rein effect and active control would stabilize the glenohumeral joint in the ABER position in patients after RMBR. STUDY DESIGN Controlled laboratory study. METHODS We included 42 participants-22 patients in group A who met the inclusion criteria after RMBR and 20 healthy participants in group B without shoulder laxity. Three-dimensional magnetic resonance imaging was performed to analyze the alignment relationship of the glenohumeral joint with and without muscular activity. Ultrasonic shear wave elastography was used to evaluate the elastic properties of the anterior capsule covered with the anterior bands of the inferior glenohumeral ligament. RESULTS Patients who underwent RMBR demonstrated more posterior (-1.81 ± 1.19 mm vs -0.76 ± 1.25 mm; P = .008) and inferior (-1.05 ± 0.62 mm vs -0.45 ± 0.48 mm; P = .001) shifts of the humeral head rotation center and less anterior capsular elasticity (70.07 ± 22.60 kPa vs 84.01 ± 14.08 kPa; P = .023) than healthy participants in the resting ABER state. More posterior (-3.17 ± 0.84 mm vs -1.81 ± 1.19 mm; P < .001) and less-inferior (-0.34 ± 0.56 mm vs -1.05 ± 0.62 mm; P < .001) shifts of the humeral head rotation center and less anterior capsular elasticity (36.57 ± 13.89 kPa vs 70.07 ± 22.60 kPa; P < .001) were observed in the operative shoulder during muscle-active ABER than in resting ABER states. CONCLUSION The check-rein effect and muscle-active control act as stabilizing mechanisms in RMBR during the ABER position. CLINICAL RELEVANCE Stabilizing mechanisms in RMBR during the ABER position include the check-rein effect and muscle-active control.
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Affiliation(s)
- Fei Zhang
- Chinese People's Liberation Army Medical School, Beijing, China; Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weixiong Liao
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianghui Chen
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baoxiang Zhang
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lin Xu
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiaolin Wang
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yaqiong Zhu
- The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yangmu Fu
- Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wentao Xiong
- Chinese People's Liberation Army Medical School, Beijing, China; Department of Orthopedic Surgery, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shoulong Song
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xianhao Sheng
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huayi Gao
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shengwei Lai
- Chinese People's Liberation Army Medical School, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qiang Zhang
- Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
- Investigation performed at the Department of Orthopedic Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
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van de Kuit A, Verweij LP, Priester-Vink S, Veeger H(D, van den Bekerom MP. Changes in Scapular Function, Shoulder Strength, and Range of Motion Occur After Latarjet Procedure. Arthrosc Sports Med Rehabil 2023; 5:100804. [PMID: 37822673 PMCID: PMC10562159 DOI: 10.1016/j.asmr.2023.100804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/17/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose To evaluate the current literature on the effects of anatomic changes caused by the Latarjet procedure and to identify areas for future research. Methods English-language studies that addressed the consequences of anatomic alterations after the open Latarjet procedure were included. Articles written in languages other than English, reviews, and case reports were excluded. Titles and abstracts were screened by 2 authors. Studies that met the inclusion criteria were screened by the same authors. The following data were extracted from the included studies: authors, year of publication, journal, country of origin, aims or purpose, study population and sample size, methods, procedure, intervention type, and key findings that relate to the scoping review questions. Results Twenty-two studies were included for analysis, yielding the following findings: First, the Latarjet procedure may change the position of the scapula owing to pectoralis minor tenotomy and/or transfer of the conjoint tendon. Second, dissection of the coracoacromial ligament may result in increased superior translation of the humeral head. The impact of this increased translation on patients' function remains unclear. Third, the subscapularis split shows, overall, better internal rotation strength compared with subscapularis tenotomy. Fourth, passive external rotation may be limited after capsular repair. Fifth, despite the movement of the conjoint tendon, elbow function seems unchanged. Finally, the musculocutaneous nerve is lengthened with a changed penetration angle into the coracobrachialis muscle, but the clinical impact seems limited. Conclusions The Latarjet procedure leads to anatomic and biomechanical changes in the shoulder. Areas of future research may include better documentation of scapular movement (bilateral, as well as preoperative and postoperative) and elbow function, the effect of (degenerative) rotator cuff ruptures after the Latarjet procedure on shoulder function, and the impact of capsular closure and its contribution to the development of glenohumeral osteoarthritis. Clinical Relevance This comprehensive overview of anatomic changes after the Latarjet procedure, with its effects on shoulder and elbow function, showed gaps in the current literature. Orthopaedic shoulder surgeons and physical therapists could use our findings when providing patient information and performing future clinical research.
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Affiliation(s)
- Anouk van de Kuit
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Lukas P.E. Verweij
- Department of Orthopaedic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Simone Priester-Vink
- Department of Research and Epidemiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - H.E.J. (Dirkjan) Veeger
- Department of Biomechanical Engineering, Faculty 3mE, Technical University Delft, Delft, The Netherlands
| | - Michel P.J. van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije University Medical Center Amsterdam, Amsterdam, The Netherlands
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Four-dimensional computed tomography evaluation of shoulder joint motion in collegiate baseball pitchers. Sci Rep 2022; 12:3231. [PMID: 35217693 PMCID: PMC8881615 DOI: 10.1038/s41598-022-06464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/24/2022] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study is to evaluate the glenohumeral contact area, center of glenohumeral contact area, and center of humeral head during simulated pitching motion in collegiate baseball pitchers using four-dimensional computed tomography (4D CT). We obtained 4D CT data from the dominant and non-dominant shoulders of eight collegiate baseball pitchers during the cocking motion. CT image data of each joint were reconstructed using a 3D reconstruction software package. The glenohumeral contact area, center of glenohumeral contact area, center of humeral head, and oblateness of humeral head were calculated from 3D bone models using customized software. The center of glenohumeral contact area translated from anterior to posterior during maximum external rotation to maximum internal rotation (0.58 ± 0.63 mm on the dominant side and 0.99 ± 0.82 mm on the non-dominant side). The center of humeral head translated from posterior to anterior during maximum external rotation to maximum internal rotation (0.76 ± 0.75 mm on the dominant side and 1.21 ± 0.78 mm on the non-dominant side). The increase in anterior translation of the center of glenohumeral contact area was associated with the increase in posterior translation of the center of humeral head. Also, the increase in translation of the center of humeral head and glenohumeral contact area were associated with the increase in oblateness of the humeral head. 4D CT analyses demonstrated that the center of humeral head translated in the opposite direction to that of the center of glenohumeral contact area during external rotation to internal rotation in abduction in the dominant and non-dominant shoulders. The oblateness of the humeral head may cause this diametric translation. 4D CT scanning and the software for bone surface modeling of the glenohumeral joint enabled quantitative assessment of glenohumeral micromotion and be used for kinematic evaluation of throwing athletes.
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Matsumura N, Oki S, Fukasawa N, Matsumoto M, Nakamura M, Nagura T, Yamada Y, Jinzaki M. Glenohumeral translation during active external rotation with the shoulder abducted in cases with glenohumeral instability: a 4-dimensional computed tomography analysis. J Shoulder Elbow Surg 2019; 28:1903-1910. [PMID: 31204064 DOI: 10.1016/j.jse.2019.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/16/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although glenohumeral instability is common, the mechanism of instability remains unclear. The purpose of this study was to quantitatively evaluate humeral head translation during active external rotation with abduction in patients with glenohumeral instability by use of 4-dimensional computed tomography scans. METHODS Ten patients with unilateral glenohumeral instability with a positive fulcrum test were prospectively included in this study. Sequential computed tomography of bilateral shoulders during active external rotation at 90° of shoulder abduction was performed for 6 seconds at 5 frames per second. The 3-dimensional positions of the humeral head center in the anteroposterior, superoinferior, and mediolateral directions were calculated at 0°, 20°, 40°, 60°, and maximum shoulder abduction-external rotation from the starting position. Translation of the humeral head center from the starting position was evaluated using Dunnett multiple-comparison tests, and the differences between the affected and intact shoulders were assessed using Wilcoxon signed rank tests. RESULTS The humeral head center translated posteriorly, inferiorly, and medially during glenohumeral external rotation with the shoulder in the abducted position on the intact side. However, the affected humeral head showed significantly less posterior translation (P = .028), greater inferior translation (P = .047), and less medial translation (P = .037) than the contralateral side. CONCLUSIONS This study indicated that dysfunction of the anterior band of the inferior glenohumeral ligament causes decreased posterior, increased inferior, and decreased medial translation of the humeral head during active shoulder abduction-external rotation.
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Affiliation(s)
- Noboru Matsumura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
| | - Naoto Fukasawa
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, School of Medicine, Keio University, Tokyo, Japan
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