Importance of the subscapularis muscle after total shoulder arthroplasty

被引:36
作者
Terrier, A. [1 ]
Larrea, X. [1 ]
Camine, V. Malfroy [1 ]
Pioletti, D. P. [1 ]
Farron, A. [2 ,3 ]
机构
[1] Ecole Polytech Fed Lausanne, Lab Biomech Orthoped, CH-1015 Lausanne, Switzerland
[2] Univ Hosp Ctr, Serv Orthopaed & Traumatol, CH-1011 Lausanne, Switzerland
[3] Univ Lausanne, CH-1011 Lausanne, Switzerland
关键词
Shoulder; Rotator cuff muscles; Arthroplasty; Musculoskeletal model; ROTATOR CUFF TEARS; FINITE-ELEMENT ANALYSIS; HUMERUS TRANSLATION; GLENOHUMERAL JOINT; UPPER EXTREMITY; IN-VIVO; MODEL; REPLACEMENT; FORCES; KINEMATICS;
D O I
10.1016/j.clinbiomech.2012.11.010
中图分类号
R318 [生物医学工程];
学科分类号
0831 ;
摘要
Background: The rotator cuff muscles are the main stabilizer of the glenohumeral joint. After total shoulder arthroplasty using anterior approaches, a dysfunction of the subscapularis muscle has been reported. In the present paper we tested the hypothesis that a deficient subscapularis following total shoulder arthroplasty can induce joint instability. Methods: To test this hypothesis we have developed an EMG-driven musculoskeletal model of the glenohumeral joint. The model was based on an algorithm that minimizes the difference between measured and predicted muscular activities, while satisfying the mechanical equilibrium of the glenohumeral joint. A movement of abduction in the scapular plane was simulated. We compared a normal and deficient subscapularis. Muscle forces, joint force, contact pattern and humeral head translation were evaluated. Findings: To satisfy the mechanical equilibrium, a deficient subscapularis induced a decrease of the force of the infraspinatus muscle. This force decrease was balanced by an increase of the supraspinatus and middle deltoid. As a consequence, the deficient subscapularis induced an upward migration of the humeral head, an eccentric contact pattern and higher stress within the cement. Interpretation: These results confirm the importance of the suscapularis for the long-term stability of total shoulder arthroplasty. (C) 2012 Elsevier Ltd. All rights reserved.
引用
收藏
页码:146 / 150
页数:5
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