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Carreira LM, Alves J, Inacio F, Pires G, Azevedo P. Sex diferences in serum and synovial fluid C-reactive protein concentration in healthy dogs. Vet Res Commun 2024:10.1007/s11259-024-10386-0. [PMID: 38662317 DOI: 10.1007/s11259-024-10386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
Differences between serum C-reactive protein (SCRP) and synovial fluid C-reactive protein (SFCRP) concentrations in healthy animals may be influenced by the sex of the individual and associated with various factors. The objective of this study was to evaluate the disparities in SCRP and SFCRP concentrations between females and males, as well as within each sex. Sixty healthy dogs (N = 60), comprising both sexes, were enrolled in the study. Peripheral blood and knee synovial fluid samples were collected for SCRP and SFCRP analysis, respectively. Serum C-reactive protein (SCRP) and SFCRP concentrations were measured, with mean of 9.61 ± 4.96 mg/L for SCRP and 1.28 ± 3.05 mg/L for SFCRP. Notably, SFCRP concentrations were consistently lower than SCRP concentrations in both sexes. Statistically significant differences were observed between sexes for both SCRP (P = 0.021) and SFCRP (P = 0.007). Further analysis within females revealed statistically significant differences between SCRP and SFCRP concentrations (P = 0.002), whereas in males, such differences were not significant (P = 0.175). Additionally, weak correlations were found between SCRP and SFCRP concentrations for both sexes (females r = 0.07; males r = 0.29). Joint capsule thickness was assessed using ultrasonography, revealing thicker joint capsules in males. A robust positive association was noted between joint capsule thickness and the SFCRP concentration in both sexes. These findings offer valuable insights into the dynamics of CRP in the context of joint health in male and female patients, elucidating the underlying pathological mechanisms of joint disease and inflammation. Overall, this underscores the importance of considering sex-specific factors in the assessment and management of joint health, as well as in the design and interpretation of studies involving SFCRP concentrations.
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Affiliation(s)
- L Miguel Carreira
- Anjos of Assis Veterinary Medicine Centre - CMVAA, Rua D.ª Francisca da Azambuja Nº9 -9A, 2830-077, Barreiro, Portugal.
- Department of Clinics - Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV-ULisboa), Av. da Universidade Técnica de Lisboa, Polo Universitário Alto da Ajuda, 1300-477, Lisbon, Portugal.
- Interdisciplinary Centre for Research in Animal Health (CIISA) - University of Lisbon, (FMV/ULisboa) Av. da Universidade Técnica, 1300-477, Lisbon, Portugal.
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300, Lisbon, Portugal.
- Faculty of Amercian, LASER Study Club - ALSC, Altamonte Springs, FL, 32714, USA.
- Privat Human Dentistry (PHD), 1200, Lisbon, Portugal.
| | - J Alves
- Divisão de Medicina Veterinária, Guarda Nacional Republicana (GNR), Rua Presidente Arriaga, 9, 1200-771, Lisbon, Portugal
| | - F Inacio
- Department of Clinics - Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV-ULisboa), Av. da Universidade Técnica de Lisboa, Polo Universitário Alto da Ajuda, 1300-477, Lisbon, Portugal
| | - G Pires
- Department of Clinics - Surgery, Faculty of Veterinary Medicine, University of Lisbon (FMV-ULisboa), Av. da Universidade Técnica de Lisboa, Polo Universitário Alto da Ajuda, 1300-477, Lisbon, Portugal
- Interdisciplinary Centre for Research in Animal Health (CIISA) - University of Lisbon, (FMV/ULisboa) Av. da Universidade Técnica, 1300-477, Lisbon, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300, Lisbon, Portugal
| | - P Azevedo
- Anjos of Assis Veterinary Medicine Centre - CMVAA, Rua D.ª Francisca da Azambuja Nº9 -9A, 2830-077, Barreiro, Portugal
- Faculty of Amercian, LASER Study Club - ALSC, Altamonte Springs, FL, 32714, USA
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Chen M, Feng S, Chen Y, Ding Z, Xie Y, Chen J, Hua Y, Chen J, Yang J, Chen S. Sex-Based Differences in Clinical Outcomes After Arthroscopic Anterior Shoulder Stabilization: Results at 5-Year Follow-up. Orthop J Sports Med 2021; 9:23259671211008841. [PMID: 34095327 PMCID: PMC8142006 DOI: 10.1177/23259671211008841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background The influence of patient sex on clinical outcomes after arthroscopic anterior shoulder stabilization is unclear. Purpose To investigate sex-based differences in clinical outcomes after arthroscopic anterior shoulder stabilization. Study Design Cohort study; Level of evidence, 3. Methods A retrospective study was conducted among 76 patients who underwent arthroscopic anterior shoulder stabilization from February 2010 to December 2017. The patients were grouped by sex. The recurrence rate of instability was compared, as were pre- and postoperative pain scores, functional outcome scores, and active range of motion (ROM). Postoperative magnetic resonance imaging (MRI) was also performed for structural assessment of the glenohumeral joint. Results No significant difference was found in the recurrence rate between female and male patients (13.3% vs 14.8%; P ≥ .999; risk ratio, 1.107 [95% CI, 0.266-4.597]). Compared with male patients, female patients had a significantly lower preoperative Constant score (94.4 ± 6.4 vs 85.4 ± 11.1; P = .002), forward flexion (173.8° ± 10.7° vs 154.0° ± 33.8°; P = .011), abduction (171.0° ± 18.4° vs 142.7° ± 39.9°; P = .001), and external rotation (76.6° ± 21.6° vs 67.7° ± 20.4°; P = .037). Postoperatively, female patients had a significantly lower Simple Shoulder Test score compared with men (8.8 ± 1.9 vs 10.3 ± 1.6; P = .005). The mean changes from pre- to postoperative Rowe score (43.6 ± 21.4 vs 31.5 ± 19.8; P = .044), Constant score (9.9 ± 8.9 vs 0.8 ± 8.1; P = .002), forward flexion (24.0 ± 36.2 vs 4.2 ± 10.9; P = .013), abduction (36.0 ± 38.3 vs 7.6 ± 18.4; P < .001), and external rotation (19.7 ± 21.3 vs 6.7 ± 26.2; P = .023) in female patients were significantly higher than those in the men. There were no sex-based differences on any MRI parameter measured. Conclusion Female patients had a similar recurrence rate as that of male patients after arthroscopic anterior shoulder stabilization. Most postoperative clinical outcome measures showed no significant difference between the sexes. Despite worse preoperative values, more significant improvements in postoperative shoulder function and active ROM were seen in women.
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Affiliation(s)
- Mo Chen
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Sijia Feng
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuzhou Chen
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zheci Ding
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuxue Xie
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jiwu Chen
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yinghui Hua
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jun Chen
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jianjun Yang
- Department of Orthopaedics, Tenth People's Hospital of Tongji University, Shanghai, People's Republic of China
| | - Shiyi Chen
- Sports Medicine Institute, Department of Sports Medicine and Arthroscopy, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
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Bonilla KA, Pardes AM, Freedman BR, Soslowsky LJ. Supraspinatus Tendons Have Different Mechanical Properties Across Sex. J Biomech Eng 2020; 141:2701591. [PMID: 30167668 DOI: 10.1115/1.4041321] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 12/31/2022]
Abstract
Sex differences in the mechanical properties of different musculoskeletal tissues and their impact on tendon function and disease are becoming increasingly recognized. Tendon mechanical properties are influenced by the presence or absence of sex hormones and these effects appear to be tendon- or ligament-specific. The objective of this study was to determine how sex and hormone differences in rats affect supraspinatus tendon and muscle properties. We hypothesized that male supraspinatus tendons would have increased cross-sectional area but no differences in tendon material properties or muscle composition when compared to supraspinatus tendons from female or ovariectomized (OVX) female rats. Uninjured supraspinatus tendons and muscles from male, female, and OVX female rats were collected and mechanical and histological properties were determined. Our analysis demonstrated decreased dynamic modulus and increased hysteresis and cross-sectional area in male tendons. We found that male tendons exhibited decreased dynamic modulus (during low strain frequency sweep and high strain fatigue loading), increased hysteresis, and increased cross-sectional area compared to female and OVX female tendons. Despite robust mechanical differences, tendon cell density and shape, and muscle composition remained unchanged between groups. Interestingly, these differences were unique compared to previously reported sex differences in rat Achilles tendons, which further supports the concept that the effect of sex on tendon varies anatomically. These differences may partially provide a mechanistic explanation for the increased rate of acute supraspinatus tendon ruptures seen in young males.
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Affiliation(s)
- K A Bonilla
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA 19104
| | - A M Pardes
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA 19104
| | - B R Freedman
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA 19104.,John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02115
| | - L J Soslowsky
- McKay Orthopaedic Laboratory, University of Pennsylvania, Stemmler Hall, 3450 Hamilton Walk, Philadelphia, PA 19104 e-mail:
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Rahnemai-Azar AA, Miller RM, Guenther D, Fu FH, Lesniak BP, Musahl V, Debski RE. Structural Properties of the Anterolateral Capsule and Iliotibial Band of the Knee. Am J Sports Med 2016; 44:892-7. [PMID: 26811306 DOI: 10.1177/0363546515623500] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of the anterolateral capsule in knee stability has recently been advocated by studies reporting that a distinct ligament exists in this area. Defining the structural properties of the anterolateral capsule can provide insight into its contribution to joint stability. The structural properties of the iliotibial band also need to be determined, as it is a common graft used for extra-articular tenodesis. PURPOSE/HYPOTHESIS The purpose of this study was to determine the structural properties of the anterolateral capsule and iliotibial band. The hypothesis was that the iliotibial band will have comparable structural properties to the anterolateral capsule because it is generally an accepted graft for extra-articular reconstruction surgeries. STUDY DESIGN Controlled laboratory study. METHODS Nine human cadaveric knees (average age, 57 ± 10 years) were dissected to assess the presence of a discrete capsular thickness originating from the lateral femoral epicondyle to the lateral tibial plateau between the Gerdy tubercle and the fibular head. For each knee, 2 constructs were prepared: (1) a bone-anterolateral capsule-bone specimen and (2) a strip of iliotibial band attached to the Gerdy tubercle. Structural properties, including ultimate load, ultimate elongation, and stiffness, were determined for the anterolateral capsule and the iliotibial band. After tensile testing, plain radiographs were obtained for evaluation of the Segond fracture. A paired t test was used to compare the structural properties of the anterolateral capsule with the iliotibial band. Significance was set at P < .05. RESULTS Two of the 9 specimens were found to have a discrete thickening of the anterolateral capsule. The iliotibial band had almost 50% higher ultimate load and nearly 3 times higher stiffness (487.9 ± 156.9 N and 73.2 ± 24.1 N/mm, respectively) compared with the anterolateral capsule (319.7 ± 212.6 N and 26.0 ± 11.5 N/mm, respectively) (P < .05 for both). The anterolateral capsule had about double the ultimate elongation compared with the iliotibial band (15.5 ± 7.3 and 8.6 ± 1.4 mm, respectively; P < .05). CONCLUSION The anterolateral capsule demonstrated significantly reduced structural properties compared with the iliotibial band. The anterolateral capsule did not have a higher ultimate load compared with the posteromedial capsule as reported in the literature. CLINICAL RELEVANCE The decision to perform an extra-articular reconstruction using an iliotibial band graft should be considered carefully. Unnecessary reconstructions using soft tissue grafts with structural properties that far exceed that of the anterolateral capsule may result in overconstraint of the ACL-reconstructed knee.
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Affiliation(s)
- Ata A Rahnemai-Azar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - R Matthew Miller
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel Guenther
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bryson P Lesniak
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Lee SY, Lee KJ, Kim W, Chung SG. Relationships Between Capsular Stiffness and Clinical Features in Adhesive Capsulitis of the Shoulder. PM R 2015; 7:1226-1234. [DOI: 10.1016/j.pmrj.2015.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/14/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
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Araki D, Miller RM, Fujimaki Y, Hoshino Y, Musahl V, Debski RE. Effect of tear location on propagation of isolated supraspinatus tendon tears during increasing levels of cyclic loading. J Bone Joint Surg Am 2015; 97:273-8. [PMID: 25695976 DOI: 10.2106/jbjs.n.00062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The morphology of the supraspinatus tendon may affect tear propagation. It was hypothesized that tears located in the anterior third of the supraspinatus tendon would propagate more readily and would require lower loads to reach critical amounts of tear propagation than those located in the middle third of the supraspinatus tendon. METHODS Twenty-three fresh-frozen human cadaveric shoulders were tested under increasing levels of cyclic loading. Tears were created in the anterior third (Group A, n=10) or the middle third (Group M, n=13) of the supraspinatus tendon. The maximum load at which a critical tear retraction was reached and the tear area for the final loading set were compared between groups. A correlation analysis was also performed for age compared with maximum load. RESULTS No significant differences were found between the anterior-third tear group (Group A) and the middle-third tear group (Group M) in maximum load (p=0.09) or tear area (p=0.6). However, Group A first reached a 100% increase in tear size at a significantly lower load than Group M (p=0.03). Strong negative correlations were detected between age and maximum load in Group A (τ=-0.82) and Group M (r=-0.63). CONCLUSIONS Other factors being equal, tears in the anterior supraspinatus tendon may propagate more readily than tears in the tendon's middle part. Age may be a factor for tear propagation. CLINICAL RELEVANCE Older patients and patients with tears in the anterior supraspinatus should be followed especially carefully.
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Affiliation(s)
- Daisuke Araki
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for D. Araki: . E-mail address for R.M. Miller: . E-mail address for Y. Fujimaki: . E-mail address for Y. Hoshino: . E-mail address for V. Musahl: . E-mail address for R.E. Debski:
| | - R Matthew Miller
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for D. Araki: . E-mail address for R.M. Miller: . E-mail address for Y. Fujimaki: . E-mail address for Y. Hoshino: . E-mail address for V. Musahl: . E-mail address for R.E. Debski:
| | - Yoshimasa Fujimaki
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for D. Araki: . E-mail address for R.M. Miller: . E-mail address for Y. Fujimaki: . E-mail address for Y. Hoshino: . E-mail address for V. Musahl: . E-mail address for R.E. Debski:
| | - Yuichi Hoshino
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for D. Araki: . E-mail address for R.M. Miller: . E-mail address for Y. Fujimaki: . E-mail address for Y. Hoshino: . E-mail address for V. Musahl: . E-mail address for R.E. Debski:
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for D. Araki: . E-mail address for R.M. Miller: . E-mail address for Y. Fujimaki: . E-mail address for Y. Hoshino: . E-mail address for V. Musahl: . E-mail address for R.E. Debski:
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for D. Araki: . E-mail address for R.M. Miller: . E-mail address for Y. Fujimaki: . E-mail address for Y. Hoshino: . E-mail address for V. Musahl: . E-mail address for R.E. Debski:
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Browe DP, Voycheck CA, McMahon PJ, Debski RE. Changes to the mechanical properties of the glenohumeral capsule during anterior dislocation. J Biomech 2013; 47:464-9. [PMID: 24315044 DOI: 10.1016/j.jbiomech.2013.10.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 10/24/2013] [Accepted: 10/31/2013] [Indexed: 11/29/2022]
Abstract
The glenohumeral joint is the most frequently dislocated major joint in the body, and instability due to permanent deformation of the glenohumeral capsule is a common pathology. The corresponding change in mechanical properties may have implications for the ideal location and extent of plication, which is a common clinical procedure used to repair the capsule. Therefore, the objective of this study was to quantify the mechanical properties of four regions of the glenohumeral capsule after anterior dislocation and compare the properties to the normal glenohumeral capsule. Six fresh-frozen cadaveric shoulders were dislocated in the anterior direction with the joint in the apprehension position using a robotic testing system. After dislocation, mechanical testing was performed on the injured glenohumeral capsule by loading the tissue samples in tension and shear. An inverse finite element optimization routine was used to simulate the experiments and obtain material coefficients for each tissue sample. Cauchy stress-stretch curves were then generated to represent the mechanical response of each tissue sample to theoretical loading conditions. Based on several comparisons (average of the material coefficients, average stress-stretch curve for each region, and coefficients representing the average curves) between the normal and injured tissue samples, the mechanical properties of the injured tissue samples from multiple regions were found to be lower than those of the normal tissue in tension but not in shear. This finding indicates that anterior dislocation primarily affects the tensile behavior of the glenohumeral capsule rather than the shear behavior, and this phenomenon could be caused by plastic deformation of the matrix, permanent collagen fiber rotation, and/or collagen fiber failure. These results suggest that plication and suturing may not be sufficient to return stability to the shoulder after dislocation in all individuals. Thus, surgeons may need to perform a procedure that reinforces or stiffens the tissue itself, such as reconstruction or augmentation, to improve repair procedures.
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Affiliation(s)
- Daniel P Browe
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, United States
| | - Carrie A Voycheck
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, United States
| | - Patrick J McMahon
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, United States
| | - Richard E Debski
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, United States.
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Browe DP, Rainis CA, McMahon PJ, Debski RE. Injury to the anteroinferior glenohumeral capsule during anterior dislocation. Clin Biomech (Bristol, Avon) 2013; 28:140-5. [PMID: 23332942 DOI: 10.1016/j.clinbiomech.2012.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 12/05/2012] [Accepted: 12/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Glenohumeral dislocation commonly results in permanent deformation of the glenohumeral capsule. Knowing the location and extent of tissue damage may aid in improving diagnostic and repair procedures for shoulder dislocations. Therefore, the objectives of this study were to determine: (1) the strain in the anteroinferior capsule at dislocation and (2) the location and extent of injury to the anteroinferior capsule due to dislocation by quantifying the resulting non-recoverable strain. METHODS A robotic/universal force-moment sensor testing system was used to anteriorly dislocate six cadaveric shoulders. The magnitude of the maximum principle strain at dislocation and the resulting non-recoverable strain due to dislocation in the anteroinferior capsule were measured by tracking the change in the location of a grid of strain markers from a reference position. FINDINGS The glenoid side of the capsule experienced higher strains at dislocation than the humeral side. The greatest strains at dislocation were found on the glenoid side of the anterior band (strain ratio of 0.60), but the greatest non-recoverable strains were found in the posterior axillary pouch (strain ratio of 0.34 on the glenoid side and 0.31 on the humeral side). INTERPRETATION These findings suggest that even though the glenoid side of the anterior band undergoes more deformation during anterior dislocation, the most permanent deformation occurs in the posterior axillary pouch, and surgeons should consider also plicating the posterior axillary pouch when performing repair procedures following anterior dislocation. In the future, the mechanical properties of the normal and injured glenohumeral capsules will be compared.
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Affiliation(s)
- Daniel P Browe
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Effects of simulated injury on the anteroinferior glenohumeral capsule. Med Biol Eng Comput 2012; 50:1299-307. [PMID: 23054378 DOI: 10.1007/s11517-012-0961-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
Glenohumeral dislocation results in permanent deformation (nonrecoverable strain) of the glenohumeral capsule which leads to increased range of motion and recurrent instability. Minimal research has examined the effects of injury on the biomechanical properties of the capsule which may contribute to poor patient outcome following repair procedures. The objective of this study was to determine the effect of simulated injury on the stiffness and material properties of the AB-IGHL during tensile deformation. Using a combined experimental and computational methodology, the stiffness and material properties of six AB-IGHL samples during tensile elongation were determined before and after simulated injury. The AB-IGHL was subjected to 12.7 ± 3.2 % maximum principal strain which resulted in 2.5 ± 0.9 % nonrecoverable strain. The linear region stiffness and modulus of stress-stretch curves between the normal (52.4 ± 30.0 N/mm, 39.1 ± 26.6 MPa) and injured (64.7 ± 21.3 N/mm, 73.5 ± 53.8 MPa) AB-IGHL increased significantly (p = 0.03, p = 0.04). These increases suggest that changes in the tissue microstructure exist following simulated injury. The injured tissue could contain more aligned collagen fibers and may not be able to support a normal range of joint motion. Collagen fiber kinematics during simulated injury will be examined in the future.
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Abstract
Glenohumeral joint posterior capsule contracture may cause shoulder pain by altering normal joint mechanics. Contracture is commonly noted in throwing athletes but can also be present in nonthrowers. The cause of contracture in throwing athletes is assumed to be a response to the high amount of repetitive tensile force placed on the tissue, whereas the mechanism of contracture in nonthrowers is unknown. It is likely that mechanical and cellular processes interact to increase the stiffness and decrease the compliance of the capsule, although the exact processes that cause a contracture have not been confirmed. Cadaver models have been used to study the effect of posterior capsule contracture on joint mechanics and demonstrate alterations in range of motion and in humeral head kinematics. Imaging has been used to assess posterior capsule contracture, although standard techniques and quantification methods are lacking. Clinically, contracture manifests as a reduction in glenohumeral internal rotation and/or cross body adduction range of motion. Stretching and manual techniques are used to improve range of motion and often decrease symptoms in painful shoulders.
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Affiliation(s)
- Amitabh Dashottar
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - John Borstad
- Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
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