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Background: Different operative techniques for transfer of the pectoralis major tendon have been proposed for the treatment of irreparable ruptures of the subscapularis tendon. The objective of this study was to compare the effects of two techniques of transferring the pectoralis major tendon (above or underneath the conjoint tendon) on glenohumeral kinematics during active abduction in a biomechanical model of a subscapularis-deficient shoulder.Methods: Six shoulder specimens were tested with a custom dynamic shoulder testing apparatus. After the kinematics of the intact shoulder were recorded, a complete tear of the subscapularis tendon was simulated surgically. A transfer of the clavicular portion of the pectoralis major muscle to the lesser tuberosity was then performed with the transferred tendon placed either above (tendon-transfer 1) or underneath (tendon-transfer 2) the conjoint tendon. For each condition, the maximum abduction angle as well as the external rotation angle and the superoinferior and anteroposterior humeral translations at the maximum abduction angle were recorded.Results: With the rotator cuff intact, the mean maximum glenohumeral abduction angle (and standard error of the mean) was 86.3 degrees +/- 2.1 degrees and the mean amount of external rotation at the maximum abduction angle was 5.5 degrees +/- 7.6 degrees . A complete tear of the subscapularis tendon decreased the mean maximum abduction angle to 40.8 degrees +/- 2.4 degrees (p < 0.001) and increased the mean external rotation to 91.8 degrees +/- 4.8 degrees (p < 0.001). The mean humeral translations in the anterior and superior directions (+3.4 +/- 0.5 and +6.3 +/- 0.3 mm, respectively) at the maximum abduction angle were also increased (p < 0.01 and p < 0.001) when compared with those in the intact shoulder. Significant differences were found in the mean maximum abduction angle as well as the mean external rotation angle and humeral translations (anterior and superior) at maximum abduction between the tendon-transfer-1 condition (63.2 degrees +/- 13.5 degrees , 82.4 degrees +/- 6.6 degrees , 4.0 +/- 1.8 mm, and 3.3 +/- 1.9 mm, respectively) and tendon-transfer-2 condition (89.5 degrees +/- 12.3 degrees , 45.7 degrees +/- 22.5 degrees , -0.6 +/- 2.0 mm, and 0.5 +/- 2.3 mm, respectively). The tendon-transfer-2 condition restored glenohumeral kinematics that were closer to those in the intact shoulder than were those resulting from the tendon-transfer-1 condition.Conclusions: Transfer of the pectoralis major tendon in subscapularis-deficient shoulders partially restored the glenohumeral kinematics of the intact shoulder. One possible explanation for the superior effect of the tendon-transfer-2 condition is that, with a pectoralis major tendon transfer underneath the conjoint tendon, the line of action of the transferred tendon is closer to that of the subscapularis muscle. [ABSTRACT FROM AUTHOR]

BACKGROUND: In many sports, female athletes have a higher incidence of anterior cruciate ligament injury than do male athletes. Among many risk factors, the lower rotatory joint stiffness of female knees has been suggested for the increased rate of anterior cruciate ligament injuries. HYPOTHESIS: In response to combined rotatory loads, female knees have significantly lower torsional joint stiffness and higher rotatory joint laxity than do male knees at low flexion angles, despite the fact that no such gender differences would be found in response to an anterior tibial load. STUDY DESIGN: Comparative laboratory study. METHODS: Joint kinematics of 82 human cadaveric knees (38 female, 44 male) in response to (1) combined rotatory loads of 10 N.m valgus and +/- 5 N.m internal tibial torques and (2) a 134-N anterior-posterior tibial load were measured using a robotic/universal force-moment sensor testing system. RESULTS: In response to combined rotatory loads, female knees had as much as 25% lower torsional joint stiffness (female: 0.79 N.m/deg; 95% confidence interval, 0.67-0.91; male: 1.06 N.m/deg; 95% confidence interval, 0.95-1.17) and up to 35% higher rotatory joint laxity (female: 26.2 degrees ; 95% confidence interval, 24.5 degrees -27.9 degrees ; male: 20.5 degrees ; 95% confidence interval, 18.8 degrees -22.2 degrees ) than did male knees (P < .05), whereas there were no gender differences in response to the anterior tibial load (P > .05). CONCLUSION: Female knees had lower torsional joint stiffness and higher rotatory joint laxity than did male knees in response to combined rotatory loads. CLINICAL RELEVANCE: Larger axial rotations of female knees in response to rotatory loads may affect the distribution of forces in soft tissues and the function of muscles that provide knee stability. Control algorithms used during the biomechanical testing of cadaveric knees and computational knee models might need to be gender specific. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knee kinematics and in situ forces resulting from anterior cruciate ligament reconstructions with 2 femoral tunnel positions were evaluated. HYPOTHESIS: A graft placed inside the anatomical footprint of the anterior cruciate ligament will restore knee function better than a graft placed at a position for best graft isometry. STUDY DESIGN: Controlled laboratory study. METHODS: Ten cadaveric knees were tested in response to a 134-N anterior load and a combined 10-N.m valgus and 5-N.m internal rotation load. A robotic universal force-moment sensor testing system was used to apply loads, and resulting kinematics were recorded. An active surgical robot system was used for positioning tunnels in 2 locations in the femoral notch: inside the anatomical footprint of the anterior cruciate ligament and a position for best graft isometry. The same quadrupled hamstring tendon graft was used for both tunnel positions. The 2 loading conditions were applied. RESULTS: At 30 degrees of knee flexion, anterior tibial translation in response to the anterior load for the intact knee was 9.8 +/- 3.1 mm. Both femoral tunnel positions resulted in significantly higher anterior tibial translation (position 1: 13.8 +/- 4.6 mm; position 2: 16.6 +/- 3.7 mm; P < .05). There was a significant difference between the 2 tunnel positions. At the same flexion angle, the anterior tibial translation in response to the combined load for the intact knee was 7.7 +/- 4.0 mm. Both femoral tunnel positions resulted in significantly higher anterior tibial translation (position 1: 10.4 +/- 5.5 mm; position 2: 12.0 +/- 5.2 mm; P < .05), with a significant difference between the tunnel positions. CONCLUSION: Neither femoral tunnel position restores normal kinematics of the intact knee. A femoral tunnel position inside the anatomical footprint of the anterior cruciate ligament results in knee kinematics closer to the intact knee than does a tunnel position located for best graft isometry. CLINICAL RELEVANCE: Anatomical femoral tunnel position is important in reproducing function of the anterior cruciate ligament. [ABSTRACT FROM AUTHOR]

BACKGROUND: The effect on joint stability of repair of type II superior labrum and biceps anchor lesions is unknown. HYPOTHESIS: Increased translations of the glenohumeral joint after a simulated type II lesion will be reduced after the lesion is repaired. STUDY DESIGN: Controlled laboratory study. METHODS: A robotic/universal force-moment testing system was used to simulate load-and-shift and apprehension tests on eight cadaveric shoulders to determine joint kinematics of the shoulder after venting, creation of a type II lesion, and repair of the lesion. RESULTS: At 30 degrees of abduction, anterior translation of the vented joint in response to an anterior load was 18.7 +/- 8.5 mm and was significantly increased to 26.2 +/- 6.5 mm after simulation of a type II lesion. Repair did not restore anterior translation (23.9 +/- 8.6 mm) to that of the vented joint. The inferior translation that also occurred during application of an anterior load was 3.8 +/- 4.0 mm in the vented joint and increased significantly to 8.5 +/- 5.4 mm with a simulated type II lesion. After repair, the inferior translation decreased significantly to 6.7 +/- 5.3 mm. CONCLUSIONS: Repair of a type II lesion only partially restored glenohumeral translations to that of the vented joint. CLINICAL RELEVANCE: Surgical techniques including improved repair of passive stabilizers injured in the type II lesion should be considered. [ABSTRACT FROM AUTHOR]

In an attempt to understand better the contribution of the anteroinferior and posterosuperior popliteomeniscal fasciculi to lateral meniscus stability, we objectively evaluated the stability of the lateral meniscus before and after sequentially sectioning these fasciculi. In the biomechanical model, we attempted to account for the inherent limitations of arthroscopic evaluation of lateral meniscal stability. When the fasciculi were intact, the average lateral meniscal motion with a 10-N load was 3.6 mm. When the anteroinferior fascicle was disrupted, the average lateral meniscal motion with a 10-N load was 5.4 mm. The mean increase in motion from the intact state was 1.8 mm or 50%, which was significant. When both fasciculi were disrupted, the average lateral meniscal motion with 10-N load was 6.4 mm. The mean increase in motion from the intact state was 2.8 mm or 78% and from the single fascicle disruption state was 1.0 mm or 18%, both differences were significant. The meniscus did not become locked with any of these loading trials, and it spontaneously reduced to the original position when unloaded. Both fasciculi make significant contributions to meniscal stability. Even though the meniscus never became locked in the joint when loaded during this study, with the variable loads seen with normal activities mechanical symptoms might be expected when meniscal motion is almost double. An increase in lateral meniscal motion at the time of surgery may aid in the diagnosis of fasciculi disruption, despite normal meniscal structure on magnetic resonance images and at arthroscopic visualization. [ABSTRACT FROM AUTHOR]

We conducted this cadaveric study to define a biomechanical rationale for rotator cuff function in several deficiency states. A dynamic shoulder testing apparatus was used to examine change in middle deltoid muscle force and humeral translation associated with simulated rotator cuff tendon paralyses and various sizes of rotator cuff tears. Supraspinatus paralysis resulted in a significant increase (101%) in the middle deltoid force required to initiate abduction. This increase diminished to only 12% for full glenohumeral abduction. The glenohumeral joint maintained ball-and-socket kinematics during glenohumeral abduction in the scapular plane with an intact rotator cuff. No significant alterations in humeral translation occurred with a simulated supraspinatus paralysis, nor with 1-, 3-, and 5-cm rotator cuff tears, provided the infraspinatus tendon was functional. Global tears resulted in an inability to elevate beyond 25 degrees of glenohumeral abduction despite a threefold increase in middle deltoid force. These results validated the importance of the supraspinatus tendon during the initiation of abduction. Glenohumeral joint motion was not affected when the 'transverse force couple' (subscapularis, infraspinatus, and teres minor tendons) remained intact. Significant changes in glenohumeral joint motion occurred only if paralysis or anatomic deficiency violated this force couple. Finally, this model confirmed that rotator cuff disease treatment must address function in addition to anatomy. [ABSTRACT FROM AUTHOR]