| Abstract ID |
| 20260038 |
| Category |
| Shoulder: Instability |
| Preferable Presentation |
| Both |
| Title |
| ARTHROSCOPIC CAPSULOLABRAL REPAIR WITH ROTATOR INTERVAL CLOSURE FOR INCOMPETENT ROTATOR INTERVAL - EVALUATION OF ROTATOR INTERVAL COMPETENCE USING PREOPERATIVE STRESS RADIOGRAPHY |
| Author |
|
| Presenter |
| Joo Han Oh |
| Abstract |
| Background: The rotator interval acts as a restraint at extreme range of motion and resists inferior translation of the humeral head in external rotation. Arthroscopic rotator interval closure (RIC) in anterior instability is known to improve shoulder stability, with most studies reporting positive clinical results. However, a few studies have reported that patients who underwent RIC experienced a decrease in external rotation after surgery. Objectives: This study aims to evaluate rotator interval competence using preoperative stress radiographs to determine the RIC indication and to analyze the clinical outcomes of arthroscopic capsulolabral repair (ACR) with RIC. Study design: Retrospective comparative study; Level III evidence. Method: Between 2010 and 2023, a total of 85 patients underwent ACR with at least 1 year of follow-up and performing stress radiographs, CT arthrography, and isokinetic muscle strength testing were analyzed retrospectively. The difference in acromiohumeral distance (ΔAHD) between neutral rotation and external rotation (ER) shoulder position on stress radiographs was measured. Incompetent RI was defined as AHD not decreasing in ER position (ΔAHD ≤ 0). Patients were divided into three groups: group A (ACR+RIC for incompetent RI [n = 41]); group B (ACR alone despite incompetent RI [n = 18]); and group C (ACR with competent RI [n = 26)]). Clinical outcomes were assessed preoperatively and at 1 year after surgery. Results: Preoperatively, demographics and clinical characteristics were not different between groups (all P > 0.05). At 1 year after surgery, RI became competent by RIC in group A in stress radiographs. pVAS, WOSI and ROMs were not different between groups (all P > 0.05). Notably, group A showed no ER loss after surgery due to RIC (P = 0.513). Although pre- and post-operative isokinetic muscle strengths were not different between groups (all P > 0.05), group B presented the worst peak torque deficit of ER after surgery (P = 0.280). There was no recurrent dislocation in all groups, but postoperative positive apprehension sign was more prevalent in group B (50.0% [9/18]) compared with group A (17.9% [7/41]) and C (34.6% [9/26]) (P = 0.046) Conclusion: Preoperative stress radiography was helpful to determine the RI incompetence in patients with anterior instability. Arthroscopic RIC for incompetent RI might be the effective procedure to reduce postoperative apprehension sign without a postoperative loss of ER. |