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Assessment of Capsular Insertion Type and Capsular Redundancy in Patients with Anterior Shoulder Instability - Quantitative Assessment with CT Arthrography


Jong Pil Yoon, MD
KOREA, REPUBLIC OF

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Assessment of Capsular Insertion Type and Capsular Redundancy in Patients with Anterior Shoulder Instability - Quantitative Assessment with CT Arthrography

Joo Han Oh, MD, PhD, KOREA, REPUBLIC OF Jun Ha Choi, MD, KOREA, REPUBLIC OF Nam Yun Chung, MD, KOREA, REPUBLIC OF Hye Yeon Choi, MD,, KOREA, REPUBLIC OF Ji-Soon Park, MD, UNITED ARAB EMIRATES Ye Hyun Lee, MD, KOREA, REPUBLIC OF Woo Kim, MD, KOREA, REPUBLIC OF Jong Pil Yoon, MD, KOREA, REPUBLIC OF

Seoul National University College of Medicine, Seongnam-Si , Gyeonggi-do , KOREA

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Anatomic Location

Shoulder Glenohumeral

Diagnosis / Condition

Instability

Treatment / Technique

Arthroscopy

Summary: The evaluation of capsular insertion type and capsular redundancy using CTA could serve as other important parameters for the management of anterior shoulder instability.

Purpose

The purposes of this study were to identify the capsular insertion type, to quantify the enlargement of capsule and to evaluate its correlation with surgical outcome in patients with anterior shoulder instability using CT arthrography (CTA).

Materials And Methods

The medical records of 71 consecutive patients (65 male and 6 female; average age, 22.4 years; range, 15-45 years) of anterior shoulder instability between April 2004 and August 2008 who underwent CTA and arthroscopic capsulolabral reconstruction surgery were retrospectively reviewed. The control group comprised 72 patients with isolated type II SLAP lesions during the same periods. Seventy nine among 143 patients were examined with follow-up CTA at average 13.8 months after surgery. CT images in the axial plane were used for the evaluation of anterior capsular insertion type and capsular redundancy. The length and cross-sectional area of 5 o'clock and 4 o'clock position of the capsule were measured at 6 and 12 mm superior to the inferior margin of glenoid rim using a picture archiving and communications system (PACS).

Results

Regarding the anterior capsular insertion type on glenoid, Type I was more common in the control group (13.9%, p < 0.05) than in the instability group (4.2%), whereas Type III in the instability group (21.1%,p < 0.05) than in the control group (9.7%). Anterior capsular length was significantly longer in the instability group at 5 o'clock (17.1% elongation, p < 0.001) and 4 o'clock position (19.2% elongation, p < 0.001) than in the control group. Anterior capsular cross-sectional area was significantly larger in the instability group at 5 o'clock (46.0% enlargement, p < 0.001) and 4 o'clock position (69.5% enlargement, p < 0.001) than in the control group. The number of dislocations and the presence of ALPSA lesion were significantly associated with anterior capsular redundancy in the instability group (p < 0.05). In the instability group, capsular length and cross-sectional area were significantly reduced in the postoperative CTA compared with those in the preoperative CTA (p < 0.001). Furthermore, postoperative capsular length and cross-sectional area in the instability group were not different with preoperative those in the control group (p > 0.05). Three patients (4.2%) in the instability group had recurrence (2 dislocations and 1 subluxation), and their anterior capsular length and cross-sectional area in the postoperative CTA were greater than those of non-recurrent patients, but those were not different between two groups in the preoperative CTA.

Conclusion

The evaluation of capsular insertion type and capsular redundancy using CTA could serve as other important parameters for the management of anterior shoulder instability.