Coracohumeral Ligament Reconstruction for Patients With Multidirectional Shoulder Instability

Aman, Zachary S.; Peebles, Liam A.; Shubert, Daniel; Golijanin, Petar; Dekker, Travis J.; Provencher, Matthew T.

doi:10.1016/j.eats.2019.01.018

Cited by 7 publications

(4 citation statements)

References 22 publications

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“…Its primary central band inserted just anterior to the apex of the humeral head cartilage (11:55 to 12:40) and just a mere 5.7 mm away from the posterior margin of the bicipital groove. As CHL reconstruction procedures for multidirectional instability are introduced into the literature, 1 the knowledge of its insertional anatomy will be essential to help reproduce its native biomechanical properties.…”

Section: Discussionmentioning

confidence: 99%

Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study

et al. 2020

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Background: While several studies have qualitatively described the anatomy of the glenohumeral ligaments, there remains a lack of consensus regarding their quantitative humeral and glenoid attachment sites. Purpose: To quantitatively and qualitatively describe the anatomic humeral and glenoid attachment sites of the glenohumeral ligaments and their relationship to well-established anatomic landmarks. Study Design: Descriptive laboratory study. Methods: A total of 10 nonpaired, fresh-frozen human cadaveric shoulders were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. All subcutaneous tissues and musculature were removed, with the exception of the rotator cuff (respective muscle bellies cut at their musculotendinous junctions) and the long head of the biceps tendon. The superior glenohumeral ligament (SGHL), middle glenohumeral ligament (MGHL), anteroinferior glenohumeral ligament (AIGHL), posteroinferior glenohumeral ligament (PIGHL), and coracohumeral ligament (CHL) were then transected. Coordinates of points along the perimeters of attachment sites were used to calculate areas, while coordinates of center points were used to determine distances between surgically relevant attachment sites and pertinent bony landmarks. Results: The mean length of the SGHL humeral attachment along the intra-articular cartilage margin was 9.5 ± 3.2 mm, spanning from 12:55 to 1:40, while the SGHL glenoid attachment to the labrum was 1.9 ± 1.2 mm medial to the most lateral extent of the labral rim, spanning from 12:30 to 12:45. The mean length of the MGHL attachment along the intra-articular cartilage margin was 16.4 ± 3.0 mm, equating to 2:10 to 3:35 on the humeral head clockface, and the glenoid attachment was confluent with the labrum, attaching 1.5 ± 1.0 mm medial to the most lateral extent of the labral rim and thus extending from 1:50 to 2:35 on the glenoid clockface. The mean length of the AIGHL attachment along the intra-articular cartilage margin was 12.0 ± 3.0 mm, spanning from 4:05 to 5:10 on the humeral head clockface. The AIGHL bony footprint on the glenoid neck was 48.4 ± 24.5 mm2. The confluent attachment of the AIGHL to the labrum was 1.2 ± 0.9 mm medial to the most lateral extent of the labral rim, corresponding to 3:30 to 4:05 on the glenoid clockface. The mean length of the PIGHL attachment along the intra-articular cartilage margin was 12.0 ± 1.4 mm, spanning from 7:40 to 8:50 on the humeral head clockface. The PIGHL attachment to the labrum was 1.2 ± 0.5 mm medial to the most lateral extent of the labral rim. This attachment to the labrum was calculated to span from 7:35 to 8:50 on the glenoid clockface. The mean length of the CHL origin from the coracoid was 12.9 mm, with its most anterior point located a mean of 14.1 mm from the tip of the coracoid. The mean length of the CHL attachment along the intra-articular cartilage margin was 10.0 ± 4.0 mm, spanning from 11:55 to 12:40 on the humeral head clockface. Conclusion: Glenohumeral ligaments were consistently identified in all specimens with minor anatomic variability for the SGHL, MGHL, AIGHL, and PIGHL. Important landmarks including the cartilage surface of the humerus, the bicipital groove, and the clockface can be utilized intraoperatively when attempting anatomic repair of these structures. Clinical Relevance: There are multiple open and arthroscopic shoulder procedures that rely on anatomic restoration of these static stabilizers to provide optimal shoulder function and prevent recurrent instability. The qualitative descriptions are comparable with current literature; however, this study is the first to quantify the glenohumeral capsular and ligamentous attachments. The data provided allow for reliable landmarks to be established from known bony and soft tissue structures.

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Section: Discussionmentioning

confidence: 99%

Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study

et al. 2020

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“…Whether CHL reconstruction may be a path to pursue, future studies will have to show. However, in anterior and multidirectional instability, the reconstruction of this part of the biceps pulley or its complete closure already has been shown 49 , 50 .…”

Section: Discussionmentioning

confidence: 99%

Association of damage to the coracohumeral ligament with anterosuperior rotator cuff degeneration revealed by anatomical dissection

Unerfußer

Schwarz

Hirtler

2022

Sci Rep

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The coracohumeral ligament (CHL) is an important structure of the biceps pulley which also merges with the rotator cuff. Which role it actually plays in the pathogenesis of rotator cuff degeneration (RCD) and rotator cuff tears (RCT) is still a point of discussion. The hypothesis of this study was, that macroscopic injury to the anterosuperior part of the rotator cuff also includes parts of or the whole CHL. Forty fresh-frozen shoulders were dissected and examined, the morphology of the rotator cuff and the coracohumeral ligament were evaluated and existing lesions documented. 27.5% of the shoulder joints showed an anterosuperior full-thickness RCT. 57.5% of all examined shoulder girdles showed at least a partial rupture of the CHL. A highly significant correlation (p < 0.001, rho = 0.529) between the presence of rotator cuff tears and ruptures of the CHL was found. Cartilage damage within the anterosuperior section of the humeral head was observed in 20% cases. In rotator cuff degeneration and atraumatic rotator cuff tears of the elderly population, the pathomechanism of full-thickness RCT is based on repetitive anterosuperior glenoid impingement. This is especially supported by the identification of a higher frequency of CHL lesions compared to RCT reported in this study. No intact CHL was identified in shoulders with damaged rotator cuff tendons.

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“…40 However, neither of these articles assessed outcomes, complications, or recurrence rates to validate these techniques in any capacity. 39,40…”

Section: Potential Future Treatment Optionsmentioning

confidence: 99%

“…38 A novel surgical technique using semitendinosus allograft to reconstruct the coracohumeral ligament has been described to theoretically restore stability to posterior and inferior translation of the shoulder because of concern that rotator interval plication may not be sufficient in patients with MDI. 39 Finally, there is a lack of data on the use of bone-based procedures for MDI likely given that bone loss is an uncommon finding in these patients. A recent technique article described using a distal tibia allograft in combination with open T-plasty capsular shift and rotator interval closure for recurrent MDI in patients with Ehlers-Danlos syndrome after a failed Latarjet.…”

Section: Potential Future Treatment Optionsmentioning

confidence: 99%

Comprehensive Review of Multidirectional Instability of the Shoulder

Hippensteel

Uppstrom

Rodeo

et al. 2023

J Am Acad Orthop Surg

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Multidirectional instability of the shoulder can result from underlying atraumatic laxity, from repetitive microtrauma, or from a traumatic injury and often occurs in association with generalized ligamentous laxity or underlying connective tissue disorders. It is critical to differentiate multidirectional instability from unidirectional instability with or without generalized laxity to maximize treatment success. Although rehabilitation is still considered the primary treatment method for this condition, surgical treatment in the form of open inferior capsular shift or arthroscopic pancapsulolabral plication is indicated if conservative treatment fails. Recent biomechanical and clinical research has shown that there is still room for improvement in the treatment methods offered to this specific patient cohort. Potential treatment options, such as various methods to improve cross-linking of native collagen tissue, electric muscle stimulation to retrain the abnormally functioning dynamic stabilizers of the shoulder, and alternative surgical techniques such as coracohumeral ligament reconstruction and bone-based augmentation procedures, are brought forth in this article as potential avenues to explore in the future.

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Coracohumeral Ligament Reconstruction for Patients With Multidirectional Shoulder Instability

Cited by 7 publications

References 22 publications

Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study

Quantitative and Qualitative Analyses of the Glenohumeral Ligaments: An Anatomic Study

Association of damage to the coracohumeral ligament with anterosuperior rotator cuff degeneration revealed by anatomical dissection

Comprehensive Review of Multidirectional Instability of the Shoulder

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