Simulated Type II Superior Labral Anterior Posterior Lesions Do Not Alter the Path of Glenohumeral Articulation: A Cadaveric Biomechanical Study

• Published in: The American journal of sports medicine 2008-04, Vol.36 (4), p.767-774
• Main Authors: Youm, Thomas, Tibone, James E., Attrache, Neal S. El, McGarry, Michelle H., Lee, Thay Q.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Athletic Injuries - physiopathology; Biological and medical sciences; Biomechanical Phenomena; Biomechanics. Biorheology; Cadaver; Care and treatment; Diseases of the osteoarticular system; Fundamental and applied biological sciences. Psychology; Humans; Injuries; Joint Instability; Kinematics; Medical sciences; Middle Aged; Orthopedics; Physiological aspects; Range of Motion, Articular - physiology; Rotation; Shoulder; Shoulder Joint - injuries; Shoulder Joint - physiopathology; Sports; Sports medicine; Tendon Injuries; Tissues, organs and organisms biophysics; Wounds and injuries
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546507312169

Background Previous studies have demonstrated increased glenohumeral translations with simulated type II superior labral anterior posterior lesions, which may explain the sensation of instability in the overhead-throwing athlete. It is unknown whether this amount of increased translation alters glenohumeral kinematics. Purpose To determine whether type II superior labral anterior posterior lesions significantly alter glenohumeral kinematics as defined by path of glenohumeral articulation in a simulated cadaveric model of the throwing shoulder. Study Design Controlled laboratory study. Methods Six cadaveric shoulders were tested for glenohumeral rotational range of motion and translation using a custom shoulder testing system and the Microscribe 3DLX. The path of glenohumeral articulation was measured by calculating the humeral head center with respect to the glenoid articular surface at maximal internal rotation, 30°, 60°, 90°, and maximal external rotation. Data were recorded for vented intact shoulders, shoulders with arthroscopically created type II superior labral anterior posterior lesions, and shoulders with arthroscopically repaired superior labral anterior posterior lesions. Results A subtle but significant increase in external rotation (2.7°) was seen after creating a type II lesion. Small increases in glenohumeral translation were found in the anterior (0.9 mm) and inferior (0.9 mm) directions with application of a 15-N force in the superior labral anterior posterior group. Increases in glenohumeral rotation and translation were restored to the intact state after repair of the lesion. No significant differences were found in the path of glenohumeral articulation for the superior labral anterior posterior condition compared with the intact shoulder. Conclusion The small amounts of increased external rotation and translation found with arthroscopically created type II superior labral anterior posterior lesions do not significantly affect glenohumeral kinematics in this passive motion model as quantified by the path of glenohumeral articulation. Clinical Relevance Findings suggest that in the absence of pain or mechanical symptoms, type II superior labral anterior posterior lesions that do not significantly involve the superior and middle glenohumeral ligaments may not need surgical repair.