Department of Bioengineering, Imperial College London, London, England.
Arthroscopy. 2013 Jun;29(6):990-7. doi: 10.1016/j.arthro.2013.02.021. Epub 2013 Apr 23.
The aims of this cadaveric study were to assess the effect of different sizes of humeral avulsion of the glenohumeral ligament (HAGL) lesions on joint laxity and to investigate any difference between repairs with anchors placed in a juxtachondral position and repairs with anchors placed in the humeral neck.
Glenohumeral specimens were tested on a shoulder laxity testing system with translations applied anteriorly up to 30 N, with the joint in 60° of glenohumeral abduction. Testing was conducted in neutral rotation and under 1-Nm external rotation for 5 specimen states: intact, medium HAGL lesion (4:30 to 5:30 clock-face position), large HAGL lesion (3:30 to 6:30 clock-face position), repair with juxtachondral suture anchors, and repair with humeral neck suture anchors.
Significant increases in translation were observed between the intact and large HAGL lesion states for neutral rotation (1.46 mm [SD, 2.33 mm] at 30 N; P = .049) and external rotation (0.81 mm [SD, 0.72 mm] at 30 N; P = .005). Significant reductions in translation were also observed between the large HAGL lesion and humeral neck repair states for neutral rotation (-1.78 mm [SD, 2.23 mm] at 30 N; P = .022) and external rotation (-0.33 mm [SD, 0.37 mm] at 30 N; P = .015).
Large HAGL lesions can increase the passive motion of the glenohumeral joint in both neutral and external rotation, although these differences are small and may be difficult to measure clinically. A repair using anchors placed in the humeral neck is more likely to restore the normal restraint to anterior translation than a juxtachondral repair.
Medium HAGL lesions are unlikely to show significant increases in joint translation, and repair of large HAGL lesions should be achieved with anchors placed in the humeral neck if possible.
本尸体研究旨在评估不同大小的肩盂下前关节囊（HAGL）撕裂对关节松弛的影响，并研究在盂肱关节软骨下和肱骨头颈部位使用锚钉修复之间的差异。
在肩关节松弛测试系统上对肱骨头进行测试，施加 30 N 的前向平移，关节处于 60°盂肱关节外展位。测试在中立位和 1-Nm 外旋位进行，共 5 个标本状态：完整、中等 HAGL 损伤（4:30 到 5:30 钟面位置）、大 HAGL 损伤（3:30 到 6:30 钟面位置）、盂肱关节软骨下缝线锚钉修复和肱骨头颈缝线锚钉修复。
与完整状态相比，大 HAGL 损伤状态下中立位（30 N 时 1.46 毫米[标准差，2.33 毫米]；P =.049）和外旋位（30 N 时 0.81 毫米[标准差，0.72 毫米]；P =.005）的平移明显增加。与肱骨头颈修复状态相比，大 HAGL 损伤状态下中立位（30 N 时-1.78 毫米[标准差，2.23 毫米]；P =.022）和外旋位（30 N 时-0.33 毫米[标准差，0.37 毫米]；P =.015）的平移明显减少。
大 HAGL 损伤可增加中立位和外旋位时盂肱关节的被动运动，尽管这些差异较小，临床上可能难以测量。与盂肱关节软骨下修复相比，使用肱骨头颈锚钉修复更有可能恢复正常的前向平移约束。
中等 HAGL 损伤不太可能导致关节平移明显增加，如果可能，应使用肱骨头颈锚钉修复大 HAGL 损伤。
