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. 2024 Feb 10:51:130-136.
doi: 10.1016/j.jor.2024.02.006. eCollection 2024 May.

Capsule elongation occurs after first time shoulder dislocation A biomechanical in-vitro investigation on human cadaveric specimen

Anna-Katharina Nolte  1 , Sebastian Jäger  1   2 , Maxime Marie Seifert  1 , Matthias Bülhoff  1 , Marcus Schiltenwolf  1 , Mareike Schonhoff  1   2 , Patric Raiss  3 , Tobias Renkawitz  1 , J Philippe Kretzer  1   2 , Benjamin Panzram  1
Affiliations

Capsule elongation occurs after first time shoulder dislocation A biomechanical in-vitro investigation on human cadaveric specimen

Anna-Katharina Nolte et al. J Orthop. .

Abstract

Purpose: As capsule elongation is assumed to weaken the static stability of the shoulder joint, the purpose of this biomechanical study was to demonstrate that capsule elongation occurs immediately after a first-time shoulder dislocation and not just after recurrent dislocation events. We hypothesize an increment in joint clearance due to joint capsule elongation after a first-time dislocation.

Methods: An experimental in-vitro study was conducted on 6 paired fresh frozen human shoulders (4 females; 2 males; 12 specimen) with a mean age of 80 (Range 67-89) years. The shoulder joint with the articular capsule was exposed and an inferior static tension force of 2.5 N was applied to the humerus prior to dislocation. Next, the humeral head was dislocated and was then immediately reduced back into the start position. The joint gap as well as joint capsule deformation was assessed using optical techniques.

Results: The radiographic joint gap increased from 13.7 ± 6.9 mm (prior to dislocation) to 18.1 ± 6.5 mm (post dislocation) (p < .001). The increase in joint clearance was 4.4 mm. The joint capsule elongated from 5.9 ± 0.005 % (prior to dislocation) to 9.4 ± 0.007 % (post dislocation) (p < .001). The mean increase in joint capsule elongation was 3.5 %.

Conclusions: Capsule elongation was observed immediately after a simulated first-time shoulder dislocation in an in-vitro model of elderly human cadavers. It might therefore not only be a phenomenon of recurrent dislocation events.

Keywords: Capsule elongation; Shoulder capsule; Shoulder dislocation; Shoulder instability.

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Conflict of interest statement

Anna-Katharina Nolte. The author declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. She is the recipient of an academic scholarship “Olympia Morata-Programm” which is financially supported by the medical faculty of the 10.13039/501100001661University of Heidelberg. Sebastian Jäger. Sebastian Jäger reports a relationship with 10.13039/100004331Johnson and Johnson that includes: funding grants. Research support from a company or supplier as a principal Investigator: 10.13039/100004331Johnson & Johnson DePuy, B. Braun Aesculap, Waldemar Link, Heraeus Medical, Zimmer Biomet, Peter Brehm GmbH, Ceramtec, Implantcast, Medacta, Mathys, Tornier. The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Maxime Seifert. The author declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Matthias Bülhoff. Matthias Bülhoff reports a relationship with Stryker Orthopaedics that includes: consulting or advisory. The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Marcus Schiltenwolf. The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Mareike Schonhoff. The author declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Patric Raiss. Patric Raiss reports a relationship with 10.13039/100007307Arthrex Inc that includes: consulting or advisory and speaking and lecture fees. Patric Raiss reports to be a consultant for Arthrex and to be a member of the executive committee of the European Society for Surgery of the Shoulder and Elbow (SECEC). The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Tobias Renkawitz. Tobias Renkawitz reports a relationship with DePuy International Ltd that includes: consulting or advisory and funding grants. Tobias Renkawitz has received research support and personal fees from ArbeitsgemeinschaftEndoprothetik (AE), DGOU, DGOOC; BVOU, DePuy International, Otto Bock Foundation, Deutsche Arthrose Hilfe, Aesculap, Zimmer, Stiftung Oskar Helene HeimBerlin, VielberthFoundation Regensburg, the German Ministry of Education and Research as well as the German Federal Ministry of Economic Cooperation and Development. He is Medical Director and Chair at the Orthopaedic Department at Heidelberg University Hospital, board member of the German Society for Orthopaedics and Trauma (DGOOC), vice president of the Professional Association of Orthopaedic Specialists and Trauma Surgeons (BVOU) and President of the German Academy of Orthopedic and Trauma Surgeons (AOUC). He is on the editorial board of „Die Orthopädie“, „Die Unfallchirurgie“, „OUMN“ (Springer, Heidelberg, Berlin, New York) and on the international advisory board of the Journal of the American Academy of Orthopedic Surgeons (AAOS) (Wolters Kluwer, Netherlands). The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Philippe Kretzer. Philippe Kretzer reports a relationship with 10.13039/100004331Johnson and Johnson that includes: consulting or advisory, funding grants, and speaking and lecture fees. Grants/Research support 10.13039/501100001659DFG - German Research Foundation 10.13039/501100002347BMBF – German 10.13039/501100002347Federal Ministry of Education and Research Gent University 10.13039/501100005986Stiftung Endoprothetik Deutsche Arthrose Stiftung Endocon GmbH Permedica S.P.A. Implantcast GmbH Mathys Orthopädie GmbH AQ Solutions GmbH Ceramtec GmbH Peter Brehm Chirurgie-Mechanik e.K. SINTX Technologies, Inc Questmed GmbH SpineServ GmbH Personal support (Consultant, Speaker or travel fees) Arbeitsgemeinschaft Endoprothetik (AE) Mathys Ltd Ceramtec GmbH DePuy Synthes/Johnson & Johnson Medical GmbH MedCert GmbH Consult Invest Beteil. GmbH Permedica S.P.A. The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Benjamin Panzram. Benjamin Panzram reports a relationship with Medartis that includes: consulting or advisory and speaking and lecture fees. The author declares that he has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Demonstration of a dissected right shoulder prior to dislocation (A) and at the timepoint of a simulated dislocation (B). A = joint capsule; B = spina scapula with optical markers moulded in a synthetic resin; C = humeral bone with optical markers; D = musculus (m.) subscapularis; E = m. Pectoralis minor and short head of biceps; F = long head of biceps.
Fig. 2
Fig. 2
Increment of the radiographic joint gap: the radiographic joint gap increased from prior to a simulated dislocation (A) (13.7 ± 6.9 mm) to 18.1 ± 6.5 mm at the time point of joint reduction (B) (p < .001). The mean increase in joint clearance was 4.4 mm.
Fig. 3
Fig. 3
Capsule elongation: Capsule elongation increased from 5.9 ± 0.005 % (prior to dislocation) (A) to 9.4 ± 0.007 %, z = −9.506 in the reduced joint position (B) (p < .001). The mean increase in joint capsule elongation was 3.5 %.
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