Evaluation of rotator cuff abduction moment arms for superior capsular reconstruction and reverse total shoulder arthroplasty

Dolan, Martine T.; Patetta, Michael J.; Pradhan, Sonia; Peresada, Dmitriy; Rybalko, Danil; Bobko, Aimee; Koh, Jason L.; Shi, Lewis L.; Goldberg, Benjamin A.; Amirouche, Farid

doi:10.1007/s00264-021-05066-6

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…Dolan et al revealed similar results when identifying that after a complete supraspinatus tear, RC muscles may produce moment arms statistically indistinguishable from that of an intact RC. 27 The use of SCR, BAR, and SCR with BAR showed no significant differences in deltoid, supraspinatus, infraspinatus, and teres minor muscle lengths during glenohumeral abduction. However, all three procedures resulted in significantly longer subscapularis muscle lengths during abduction than the intact, partially torn, and completely torn RCs.…”

Section: Discussionmentioning

confidence: 80%

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A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR

Labib

Amirouche

Pradhan

et al. 2022

Journal of Shoulder and Elbow Arthroplasty

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Introduction Current understanding of the biomechanical effects of treatment options for irreparable rotator cuff (RC) tears is lacking. This study examines how shoulder muscle lengths and excursions are affected by superior capsular reconstruction (SCR), bursal acromial reconstruction (BAR), and SCR with BAR, following a complete supraspinatus tear. Method Six fresh-frozen cadaveric shoulders were examined. Deltoid and RC muscle lengths were measured at 0, 30, 45, 60, and 90° of shoulder abduction under six conditions: (1) intact, (2) partially torn supraspinatus, (3) completely torn supraspinatus, (4) SCR, (5) SCR with BAR, and (6) BAR. Muscle excursions from 0–90° of abduction were then calculated. Results Subscapularis muscle lengths after SCR, BAR, and SCR with BAR were significantly greater (post-hoc Tukey HSD test; p < .01) compared to the other conditions. Supraspinatus, infraspinatus, teres minor, and deltoid lengths were not significantly different (ANOVA test; p > .01) between the conditions. All muscle excursions remained statistically similar between the conditions (ANOVA test; p > .01). Conclusion These findings demonstrate that the use of SCR, BAR, or SCR with BAR for a complete supraspinatus tear, may increase subscapularis muscle length while maintaining other shoulder muscle lengths. An increase in subscapularis length can allow for more effective subscapularis muscle strengthening and increased compensatory function in the long term. Additionally, all shoulder muscle excursions are preserved after partial or complete supraspinatus tears and after SCR, BAR, or SCR with BAR. Therefore, these surgical treatments can initially normalize shoulder muscle function during 0–90° of abduction, after an irreparable supraspinatus tear.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR

Labib

Amirouche

Pradhan

et al. 2022

Journal of Shoulder and Elbow Arthroplasty

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“…The machine device was designed and weighted according to the protocol described by Mihata et al 14 , 17 and as used in other similar cadaveric studies. 6 , 21 , 22 This experimental frame allowed the glenohumeral joint to be stabilized through force applied to the insertion sites of the muscles. The tendon attachments were connected to a pulley system and attached to free-hanging weights exerting the force vectors depicted in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Infraspinatus Muscle Fiber Moment Arms During Abduction: A Biomechanical Comparison of Values for Intact Rotator Cuff, Supraspinatus Tear, Superior Capsular Reconstruction, and Reverse Total Shoulder Arthroplasty

Echenique

Dolan

Koh

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Lines of action of the superior, middle, and inferior infraspinatus muscle fibers work together to produce moment arms that change throughout abduction in an intact shoulder, after a supraspinatus tear, and after superior capsular reconstruction (SCR) and reverse total shoulder arthroplasty (rTSA). Purpose: To use moment arm values to indicate the efficacy of SCR and rTSA to restore infraspinatus function during shoulder abduction. Study Design: Descriptive laboratory study. Methods: A total of 5 human cadaveric shoulders placed in a testing apparatus were each actively abducted (0°-90°) under the following 4 conditions: intact, complete supraspinatus tear, SCR, and rTSA. The 3-dimensional coordinates of points were tracked along the origin and insertion of the superior, middle, and inferior infraspinatus fibers during abduction. Moment arm values were calculated using the origin-insertion method to determine abduction contribution of infraspinatus fiber sections. Analysis of variance and post hoc Tukey testing were used to compare differences in moment arms between the 4 conditions and between fiber sections. Results: In the intact condition, the superior infraspinatus fibers had an abduction moment that decreased with elevation until shifting to adduction. Conversely, the middle and inferior fibers had an adduction moment that turned to abduction (mean moment arm values from 0° to 90°: inferior, from –5.9 to 19.4 mm; middle, from –4.7 to 15.9 mm; superior, from 5.6 to –5.1 mm; P < .05). After a supraspinatus tear, superior fibers lacked any torque, and inferior and middle fibers lost adduction potential (inferior, from 4.8 to 14.0 mm; middle, from –0.2 to 9.6 mm; superior, from 1.0 to 0.7 mm; P < .05). SCR restored the initial superior fiber abduction moment (5.6 mm at 0°; P < .05); middle and inferior fibers had some restoration but were weaker than intact fibers. Loss of abduction moment in all fibers was seen with rTSA (inferior, from –9.6 to –1.6 mm; middle, from –10.5 to –3.6 mm; superior, from –1.7 to –4.6 mm; P < .05). Conclusion: Infraspinatus fiber groups had different and inverse moment arms during scapular plane elevation. SCR most closely resembled the intact shoulder, whereas rTSA transformed the infraspinatus into an adductor. Clinical Relevance: These results support the efficacy of SCR at restoring biomechanical muscle function and suggest that the changes in moment arms for each fiber group be considered when choosing treatment modalities and rehabilitation protocols after rotator cuff tear.

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Reverse total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study

Knighton¹,

Chalmers²,

Sulkar³

et al. 2022

Journal of Shoulder and Elbow Surgery

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Evaluation of rotator cuff abduction moment arms for superior capsular reconstruction and reverse total shoulder arthroplasty

Cited by 4 publications

References 16 publications

A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR

A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR

Infraspinatus Muscle Fiber Moment Arms During Abduction: A Biomechanical Comparison of Values for Intact Rotator Cuff, Supraspinatus Tear, Superior Capsular Reconstruction, and Reverse Total Shoulder Arthroplasty

Reverse total shoulder glenoid component inclination affects glenohumeral kinetics during abduction: a cadaveric study

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