title: Effects of combined anterior and posterior plication of the glenohumeral ligament complex for the repair of anterior glenohumeral instability: a biomechanical study.
abstract: BACKGROUND
  Arthroscopic repair techniques for anterior instability most commonly address only the anterior band of the inferior glenohumeral ligament. This study quantitatively evaluated and compared the combined anterior and posterior arthroscopic plication by repairing both the anterior and posterior bands of the inferior glenohumeral ligament with the anterior arthroscopic plication alone.
  
  
  METHODS
  Six cadaveric shoulders were tested in 60° of glenohumeral abduction with 22 N of compressive force in the coronal plane for intact, after anterior capsular stretching, after anterior repair, and after posterior arthroscopic repair. Range of motion, glenohumeral translation, and glenohumeral kinematics throughout the rotational range of motion were measured with a MicroScribe 3DLX (Immersion, San Jose, CA, USA). Glenohumeral contact pressure and area were measured with a pressure measurement system (Tekscan Inc, South Boston, MA, USA).
  
  
  RESULTS
  Stretching the anterior capsule significantly increased external rotation and anterior translation (P < .05). After anterior plication, external rotation was restored to the intact condition, and anterior translation was significantly decreased compared with stretched condition (P < .05). The combined anterior and posterior plication significantly decreased internal rotation compared with the intact condition. The anterior plication shifted the humeral head posterior in external rotation, whereas the combined anterior and posterior plication shifted the humeral head anterior in internal rotation (P < .05). Both repairs led to a decrease in glenohumeral contact area at 45° external rotation (P < .07).
  
  
  CONCLUSIONS
  The addition of a posterior plication to anterior plication for anterior instability has no biomechanical advantage over a typical arthroscopic anterior repair for anterior glenohumeral instability.
authors.affiliation: Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Peltier
authors.forename: Michelle H
authors.initials: MH
authors.lastname: McGarry
authors.forename: James E
authors.initials: JE
authors.lastname: Tibone
authors.forename: Thay Q
authors.initials: TQ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001182:Arthroscopy / Q000379:methods; D001696:Biomechanical Phenomena; D002102:Cadaver; D019245:Compressive Strength; D005260:Female; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D012785:Shoulder Joint / Q000601:surgery*; D013314:Stress, Mechanical