Mueller Andreas M, Rosso Claudio, Entezari Vahid, McKenzie Brett, Hasebroock Andrew, Cereatti Andrea, Della Croce Ugo, Nazarian Ara, Ramappa Arun J, DeAngelis Joseph P
Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland.
Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Am J Sports Med. 2014 Oct;42(10):2455-62. doi: 10.1177/0363546514547348. Epub 2014 Sep 8.
Supraspinatus tears are common in pitchers. However, the effect of these tears on glenohumeral (GH) mechanics is incompletely understood.
PURPOSE/HYPOTHESIS: To describe the effect of supraspinatus tears and repairs on GH kinematics during an abbreviated throwing motion using the intact shoulder girdle. The hypothesis was that supraspinatus tears would lead to an increase of GH translation in the coronal plane and supraspinatus repairs would restore GH kinematics.
Controlled laboratory study.
Six shoulders from 3 fresh-frozen cadavers were tested in a novel 7 degrees of freedom robotic testing system. Torsos were mounted and the wrist was pinned to an actuator mounted on an upper frame. After the deltoid was removed, the shoulders were studied during an abbreviated throwing motion (ATM) from maximum external rotation to the midcoronal plane to establish a baseline. The ATM was repeated after creation of a 1-cm supraspinatus tear, after creation of a 3-cm supraspinatus tear, and after repair with a transosseous equivalent (TOE) technique. Retroreflective bone markers and high-speed infrared cameras were used to measure GH kinematics and calculate the center of rotation of the GH joint (CORGH) instantaneously.
The 1- and 3-cm supraspinatus tears did not significantly alter GH translation. The TOE repair shifted the CORGH posteriorly, as evidenced by a significant decrease in the overall GH translation in all 3 planes (P = .003, .019, and .026, for x-y, y-z, and x-z planes, respectively).
In contrast to a TOE repair of the supraspinatus tendon, isolated supraspinatus tears did not perturb GH kinematics in this cadaveric model of the throwing shoulder.
In throwing athletes, treatment of rotator cuff tears should be addressed with caution to avoid an unintended alteration in GH kinematics due to overtightening of the tendon.
冈上肌撕裂在投手群体中很常见。然而，这些撕裂对盂肱（GH）力学的影响尚未完全明确。
目的/假设：描述冈上肌撕裂及修复对使用完整肩带进行简化投掷动作时GH运动学的影响。假设是冈上肌撕裂会导致GH在冠状面的平移增加，而冈上肌修复会恢复GH运动学。
对照实验室研究。
在一个新型的7自由度机器人测试系统中对来自3具新鲜冷冻尸体的6个肩部进行测试。将躯干固定，手腕固定在安装在上部框架上的致动器上。在切除三角肌后，在从最大外旋到冠状面中部的简化投掷动作（ATM）过程中研究肩部，以建立基线。在制造1厘米冈上肌撕裂后、制造3厘米冈上肌撕裂后以及采用经骨等效（TOE）技术修复后重复进行ATM。使用反光骨标记物和高速红外摄像机即时测量GH运动学并计算GH关节旋转中心（CORGH）。
1厘米和3厘米的冈上肌撕裂并未显著改变GH平移。TOE修复使CORGH向后移位，所有三个平面的总体GH平移均显著降低（x - y、y - z和x - z平面的P值分别为0.003、0.019和0.026），证明了这一点。
与冈上肌腱的TOE修复不同，在这个投掷肩尸体模型中，孤立的冈上肌撕裂并未扰乱GH运动学。
在投掷运动员中，肩袖撕裂的治疗应谨慎进行，以避免因肌腱过度收紧导致GH运动学意外改变。
