Patient-Specific Strategies for Capsular Repair Following Shoulder Dislocations

项目摘要 创伤性肩关节脱位是一种常见于年轻运动员的损伤， 尽管进行了手术修复，但仍与复发性不稳定有关。这种反复出现的不稳定导致 由于早期骨关节炎和肩关节功能丧失而导致的长期残疾。最近我们 描述了多肩关节后关节囊损伤的位置、大小和方向 错位这些研究的结果表明， 脱位发生在手术期间先前未处理的区域，并且取决于 错位的数量。这表明可能需要一种更具损伤特异性的囊膜修复方法 以改善术后肩关节功能。建议的总体目标 本项目旨在评估多发性脱位后盂肱关节运动学的恢复情况 使用损伤特异性包膜修复策略。我们的总体假设是， 手术必须考虑损伤的程度和方向，以正确恢复正常关节 稳定实现这一目标的第一步是开发针对特定伤害的优化设计 基于不可恢复应变数据（囊损伤）的囊修复， 运动学上与完好的肩部相似。(Aim 1a）一种新型的机器人测试系统将错位 尸体肩部和模拟临床检查以评估关节稳定性。光学跟踪 系统将量化不可恢复的应变。为了将这些信息转化为临床 设置，不可恢复的应变数据将与囊表面积变化相关， 在MR关节造影片上进行定量。(Aim 1b）最后，MR关节造影将用于表征 肩关节脱位患者手术修复前后的关节囊损伤。 对侧肩关节将作为对照，并允许评估关节囊区域 目前的修复方法没有充分解决（目标2）。这项研究的结果将 进一步验证对损伤特定修复策略的需求，并提供一种解决方案， 最终将在未来的随机对照试验中实施。探索特定伤害 这些策略可以帮助改善肩关节功能，降低术后复发性不稳定的发生率。 囊修复。因此，可以制定指导运动员治疗的指南， 在整个赛季中经历多次脱臼。最后，相关的成本和残疾 与长期后遗症的多肩关节脱位将减少。

Project Summary Traumatic dislocation of the shoulder is an injury that commonly affects young athletes and has been associated with recurrent instability despite surgical repair. This recurrent instability leads to long-term disability due to early osteoarthritis and loss of shoulder function. Recently, we have characterized the location, magnitude, and direction of capsular injury following multiple shoulder dislocations. The findings of these studies show that the capsular injury pattern following dislocation occurs at regions not previously addressed during surgery and depends on the number of dislocations. This suggests that a more injury-specific capsular repair might be needed in order to improve shoulder function post-operatively. The overall objective of the proposed project is to assess the restoration of glenohumeral kinematics following multiple dislocations using injury-specific capsular repair strategies. Our overall hypothesis is that capsular plication procedures must account for magnitude and direction of injury to properly restore normal joint stability. The first step to achieve this goal is to develop an optimized design for injury-specific capsular repair based on non-recoverable strain data (capsular injury) that best restores kinematics to those of the intact shoulder. (Aim 1a) A novel robotic testing system will dislocate cadaveric shoulders and simulate clinical exams to assess joint stability. An optical tracking system will quantify the non-recoverable strain. In order to translate this information to the clinical setting, the non-recoverable strain data will be correlated with capsular surface area changes as quantified on MR arthrogram. (Aim 1b) Finally, MR arthrograms will be used to characterize capsular injury before and after surgical repair in subjects that have dislocated their shoulders. The contralateral shoulder will serve as a control and allow assessment of areas of the capsule that current repair methods do not adequately address (Aim 2). The findings of this study will further validate the need for injury-specific repair strategies and provide a solution that can ultimately be implemented in a future randomized controlled trial. Exploring injury-specific strategies can help improve shoulder function and reduce the rate of recurrent instability following capsular repair. Thus, guidelines could be developed to direct the treatment of athletes that experience multiple dislocations throughout a season. Finally, the cost and disability associated with the long-term sequelae of multiple shoulder dislocations will be reduced.