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Study questions the role rotator interval closure plays in arthroscopic stabilization
No benefit found in adding rotator interval closures to posterior, inferior stabilizations.
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FLORENCE — Routinely performing arthroscopic rotator interval closures during shoulder stabilization procedures may be unnecessary in certain cases, according to results of a new study.
In a cadaveric study, arthroscopic rotator interval (RI) closure had little effect on posterior and inferior shoulder translation, but it helped improve stability during anterior procedures, investigators said.
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“Arthroscopic RI closure does reduce the anterior translation of the humerus and may be indicated in certain cases of anterior shoulder instability. There is an accompanied loss of external rotation in the neutral position which may present a challenge,” said Timothy S. Mologne, MD, in a presentation to the 2007 International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) Congress. “Based on our findings, the routine use of RI closure when performing arthroscopic posterior shoulder stabilization should be questioned,” Mologne said.
Mologne received the ISAKOS Science Award for this research.
Anterior/posterior stabilization
Mologne and colleagues divided 14 cadaver shoulders into two groups to undergo either arthroscopic anterior or posterior stabilization. Their goal was to determine if anterior/posterior stabilization of the shoulder improved when an arthroscopic RI closure was added to an anterior or posterior arthroscopic stabilization, Mologne said.
Researchers placed the shoulders in the lateral decubitus position and performed anterior inferior or posterior inferior capsular repairs. They then performed a medial glenohumeral ligament to superior glenohumeral ligament RI closure with two #2 polyester sutures.
They then placed the shoulders in a custom apparatus to dynamically load the rotator cuff muscles and measure the translation.
Translation affected
In the anterior group, arthroscopic RI closure increased the amount of external rotation lost by the stabilization procedure and did not decrease anterior translation, Mologne said.
In the posterior group, “internal rotation was decreased with the repair, but not significantly changed by the RI closure. Posterior translation was significantly reduced following the repair, but not changed by the addition of the rotator interval closure,” he said.
Mologne told Orthopaedics Today International he studied this area after two patients treated for posterior instability with additional arthroscopic RI closures developed recurrent instability.
“I felt that rotator interval closure did not add much, if anything, to a standard arthroscopic posterior stabilization. While one needs to be careful applying bench research to clinical situations, I think we showed that arthroscopic rotator interval closure does not add posterior or inferior stability to the shoulder. … Interestingly enough, we found anterior shoulder stability was improved by an RI closure,” he said.
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Images: Mologne TS |
For more information:Reference:
- Timothy S. Mologne, MD, can be reached at Sports Medicine Center, 277 Altenhofen Drive, Appleton, WI 54913, U.S.A.; +1-920-993-1643; e-mail: drmologne@thesportsmedcenter.com. He has no direct financial interest in any products or companies mentioned in the article.
- Mologne TS, Provencher MT, Michio H, et al. The addition of rotator interval closure after arthroscopic repair of either posterior or shoulder instability: Impact on glenohumeral kinematics. #267. Presented at the 2007 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. May 27-31, 2007. Florence.