Patient-Specific Strategies for Capsular Repair Following Shoulder Dislocations

项目摘要 创伤性肩关节脱位是一种通常影响年轻运动员的损伤， 尽管进行了手术修复，但与复发的不稳定有关。这种反复出现的不稳定导致 由于早期的骨关节炎和肩部功能丧失而导致的长期残疾。最近，我们有 描述了多发性肩关节后囊损伤的位置、程度和方向 位错。这些研究的结果表明，囊膜损伤的模式如下 脱位发生在手术中以前没有处理过的区域，取决于 位错的数量。这表明可能需要进行更具损伤特异性的囊膜修复。 以改善术后肩关节功能。建议的总体目标是 该项目旨在评估多发性脱位后肩关节运动学的恢复情况。 使用损伤特定的包膜修复策略。我们的总体假设是囊膜折叠术 手术必须考虑到损伤的大小和方向，以适当地恢复正常关节 稳定性。实现这一目标的第一步是开发针对特定伤害的优化设计 基于最佳恢复的不可恢复应变数据(包膜损伤)的包膜修复 运动学与完整肩部的运动学。(目标1a)一种新的机器人测试系统将错位 身体肩膀和模拟临床检查，以评估关节的稳定性。一种光学跟踪 系统将对不可恢复的菌株进行量化。为了将这些信息转化为临床 设置时，不可恢复的应变数据将与晶状体表面积的变化相关联 在MR关节图上进行了量化。(目标1b)最后，将使用磁共振关节图来描述 肩关节脱位患者手术修复前后的包膜损伤。 对侧肩将作为对照，并允许评估胶囊的区域 目前的修复方法不能充分解决(目标2)。这项研究的结果将 进一步验证针对伤害的修复策略的必要性，并提供解决方案 最终将在未来的随机对照试验中实施。探索特定的损伤 策略可以帮助改善肩部功能，降低术后再发不稳定的几率 囊膜修补术。因此，可以制定指南来指导运动员的治疗 在一个赛季中经历多次错位。最后，与之相关的成本和残疾 具有长期后遗症的多发性肩关节脱位将会减少。

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.