title: Biomechanical Role of Capsular Continuity in Superior Capsule Reconstruction for Irreparable Tears of the Supraspinatus Tendon.
abstract: Patients with irreparable rotator cuff tears have a defect of the superior capsule, which creates discontinuity of the shoulder capsule in the transverse direction (anterior-posterior direction). This effect is one of the causes underlying shoulder instability after rotator cuff tears.
  
  
  
  The purpose of this study was to assess the effects of anterior and posterior continuity on shoulder biomechanics after superior capsule reconstruction (SCR). The hypothesis was that capsular continuity in the transverse direction would improve glenohumeral stability after SCR.
  
  
  
  Controlled laboratory study.
  
  
  
  Seven fresh-frozen cadaveric shoulders were tested by using a custom shoulder testing system. Subacromial peak contact pressure, glenohumeral superior translation, glenohumeral compression force, and glenohumeral range of motion (ROM) were compared among 5 conditions: (1) intact shoulder, (2) simulated irreparable supraspinatus tendon tear, (3) SCR without side-to-side suturing, (4) SCR with posterior side-to-side suturing, and (5) SCR with both anterior and posterior side-to-side suturing.
  
  
  
  The creation of an irreparable supraspinatus tear significantly increased glenohumeral superior translation (0° of abduction: 254% of intact [P = .04]; 30° of abduction: 200% of intact [P = .04]) and subacromial peak contact pressure (0° of abduction: 302% of intact [P = .0001]; 30° of abduction: 239% of intact [P = .0006]), decreased glenohumeral compression force (0° of abduction: 85% of intact [P = .004]; 30° of abduction: 87% of intact [P = .0002]; 60° of abduction: 88% of intact [P = .0001]), and increased total ROM (0° of abduction: 16° increase [P = .008]). SCR without side-to-side suturing significantly decreased subacromial peak contact pressure (0° of abduction: 79% of intact [P = .0001]; 30° of abduction: 91% of intact [P = .001]; 60° of abduction: 55% of intact [P = .04]) but did not inhibit glenohumeral superior translation. By adding posterior side-to-side sutures, both glenohumeral superior translation (0° of abduction: 93% of intact [P = .02]; 30° of abduction: 110% of intact [P = .04]) and subacromial peak contact pressure decreased significantly (0° of abduction: 56% of intact [P = .0001]; 30° of abduction: 83% of intact [P = .0003]; 60° of abduction: 46% of intact [P = .04]). Neither SCR with nor SCR without side-to-side suturing ameliorated the tear-associated decrease in glenohumeral compression force and increase in total ROM. Adding anterior side-to-side sutures did not change any measurements compared with SCR with posterior side-to-side suturing.
  
  
  
  SCR with side-to-side suturing completely restored the superior stability of the shoulder joint by establishing posterior continuity between the graft, residual infraspinatus tendon, and underlying shoulder capsule.
  
  
  
  Side-to-side suturing between the graft, residual infraspinatus tendon, and underlying shoulder capsule is recommended for SCR in patients with irreparable supraspinatus tendon tears to restore superior stability after surgery.
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, California, USA Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan tmihata@yahoo.co.jp tmihata@osaka-med.ac.jp.
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Mihata
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, California, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: McGarry
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, California, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kahn
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, California, USA.
authors.forename: Iliya
authors.initials: I
authors.lastname: Goldberg
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Neo
authors.affiliation: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, California, USA.
authors.forename: Thay Q
authors.initials: TQ
authors.lastname: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D012782:Shoulder / Q000502:physiology* / Q000601:surgery; D012785:Shoulder Joint / Q000502:physiology* / Q000601:surgery
keywords: capsule; defect; shoulder; side-to-side suture; stability; superior