Debski R E, Sakone M, Woo S L, Wong E K, Fu F H, Warner J J
Department of Orthopaedic Surgery, University of Pittsburgh, PA 15213, USA.
J Shoulder Elbow Surg. 1999 Jul-Aug;8(4):324-9. doi: 10.1016/s1058-2746(99)90154-4.
The passive properties of the rotator cuff have been shown to provide some stability during anterior-posterior (AP) translation. However, the relative importance of the rotator cuff to joint stability remains unclear. The purpose of this study was to quantify the force contributions of the rotator cuff and of capsuloligamentous structures at the glenohumeral joint during AP loading. We hypothesized that the rotator cuff acts as a significant passive stabilizer of the glenohumeral joint and that its contribution to joint stability is comparable to the contribution made by the components of the glenohumeral capsule. A robotic/universal force-moment sensor testing system was used to determine both the multiple "degrees of freedom" joint motion and the in situ force carried by each soft tissue structure during application of an 89N AP load at 4 abduction angles. The percent contribution of the rotator cuff to the resisting force of the intact joint during AP loading was significantly greater during posterior loading (35% +/- 26%) than during anterior loading at 60 degrees of abduction (P < .05). The contribution of the rotator cuff (i.e., 29% +/- 16% at 30 degrees of abduction) was found to be significantly greater than the contributions of the capsule components during posterior loading at 30 degrees, 60 degrees, and 90 degrees of abduction (P < .05). However, no differences could be found between the respective contributions of the rotator cuff and the capsule components during anterior loading. The results support our hypothesis and suggest that passive tension in the rotator cuff plays a more significant role than other soft tissue structures in resisting posterior loads at the glenohumeral joint. The important role of the rotator cuff during posterior loading may be a result of the thin posterior joint capsule compared with the anterior capsule, which has several thickenings. This information increases our understanding of posterior stability at the glenohumeral joint during clinical laxity tests.
肩袖的被动特性已被证明在前后（AP）平移过程中提供一定的稳定性。然而，肩袖对关节稳定性的相对重要性仍不明确。本研究的目的是量化在AP加载过程中肩袖和盂肱关节囊韧带结构在盂肱关节处的力贡献。我们假设肩袖是盂肱关节的重要被动稳定器，其对关节稳定性的贡献与盂肱关节囊各组成部分的贡献相当。使用机器人/通用力-力矩传感器测试系统来确定在4个外展角度施加89N AP载荷时的多个“自由度”关节运动以及每个软组织结构所承受的原位力。在60度外展时，肩袖对完整关节在AP加载过程中抵抗力的贡献在向后加载时（35%±26%）显著大于向前加载时（P<.05）。发现在30度、60度和90度外展时向后加载过程中肩袖的贡献（即30度外展时为29%±16%）显著大于关节囊各组成部分的贡献（P<.05）。然而，在向前加载过程中，肩袖和关节囊各组成部分的各自贡献之间未发现差异。结果支持了我们的假设，并表明肩袖中的被动张力在抵抗盂肱关节向后载荷方面比其他软组织结构发挥更重要的作用。与前部关节囊相比，后部关节囊较薄且有多处增厚，这可能是肩袖在向后加载过程中发挥重要作用的原因。这些信息增进了我们对临床松弛试验期间盂肱关节后稳定性的理解。
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