Sekiya Jon K, Willobee James A, Miller Mark D, Hickman Allison J, Willobee Ashley
MedSport, Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48106-0391, USA.
Arthroscopy. 2007 Nov;23(11):1145-51. doi: 10.1016/j.arthro.2007.05.019.
The purpose of this study was to compare a new arthroscopic technique for capsular plication with the standard open inferior capsular shift for reducing volume in a multidirectional instability model.
Seven fresh-frozen cadaveric shoulders (mean age, 55 years) were dissected down to the capsule. A viscous liquid was injected into each shoulder joint and the volume measured. An arthroscopic multi-pleated anterior, posterior, and inferior capsular plication was performed through a single anterior and posterior portal by use of bioabsorbable suture anchors. The shoulder joint volume was again measured, and the sutures were then cut to restore the volume back to the original size. A humerus-based capsular release from 4 o'clock to 6 o'clock to the 8-o'clock position (right shoulder) was performed, the capsule shifted, and the volume recorded. A repeated-measures analysis of variance test was used with significance set at P = .05.
The mean baseline shoulder volume was 20 +/- 9 mL (range, 10 to 35 mL). The arthroscopic plication resulted in a mean decrease of 58% +/- 12%. The open inferior capsular shift resulted in a mean difference of 45% +/- 11%. There was a significant decrease in volume between the arthroscopic and open capsular shifts (P = .006, beta = .92).
This study proved our hypothesis that with this new arthroscopic technique for capsular plication, arthroscopic volume reduction can be achieved at least as well as with the standard open technique.
As the clinical results in the literature improve with improvements in arthroscopic techniques for treating shoulder instability, this arthroscopic method of repair could become invaluable in overcoming the challenge of capsular volume reduction when addressing multidirectional shoulder instability arthroscopically.
本研究旨在比较一种新的关节镜下关节囊折叠技术与标准开放性下关节囊移位术在多向不稳定模型中减少关节容积的效果。
对7个新鲜冷冻的尸体肩部标本（平均年龄55岁）进行解剖直至关节囊。向每个肩关节内注入粘性液体并测量容积。通过单个前后入路，使用可生物吸收缝线锚钉进行关节镜下多褶的前、后及下关节囊折叠术。再次测量肩关节容积，然后剪断缝线使容积恢复至原始大小。进行基于肱骨的从4点至6点到8点位置（右肩）的关节囊松解，将关节囊移位并记录容积。采用重复测量方差分析检验，显著性设定为P = 0.05。
肩关节平均基线容积为20±9 mL（范围10至35 mL）。关节镜下折叠术使平均容积减少58%±12%。开放性下关节囊移位术使平均差异为45%±11%。关节镜下和开放性关节囊移位术后容积均有显著减少（P = 0.006，β = 0.92）。
本研究证实了我们的假设，即采用这种新的关节镜下关节囊折叠技术，关节镜下减少容积的效果至少与标准开放技术相同。
随着文献中关节镜治疗肩部不稳定技术的改进，临床结果不断改善，这种关节镜修复方法在关节镜治疗多向肩部不稳定时克服关节囊容积减少的挑战方面可能变得非常重要。
