The effect of subscapularis muscle contraction on coaptation of anteroinferior glenohumeral ligament–labrum complex after Bankart repair

Facilitation of healing is important for the anteroinferior glenohumeral ligament–labrum complex (AIGHL-LC) after Bankart repair in shoulder dislocation. The purpose of this study was to investigate the effect of subscapularis muscle loading on contact area and contact pressure between the subscapularis and AIGHL-LC and between the glenoid bone and the AIGHL-LC following Bankart repair. Twenty-two fresh-frozen cadaveric shoulders were used. They were attached to a shoulder-positioning device to which a compression force was applied. Loads applied to the supraspinatus, infraspinatus, and teres minor tendons were held constant. The loads applied to the subscapularis tendon were set at 0, 10, 20, and 30 Newton (N). Contact pressure and area between the subscapularis and the AIGHL-LC were measured with the arm at 4 rotational positions: 60° and 30° internal, neutral, and 30° external. After the Bankart lesion was created, the contact area and pressure between the AIGHL-LC and glenoid bone were measured while Bankart repair was performed with or without loading of the subscapularis. The contact area and pressures with 10, 20, and 30 N of subscapularis loadings were significantly greater than with 0 N of subscapularis loading at 60° internal rotation and 30° external rotation (P < .05). After Bankart repair, contact area and pressure with subscapularis loading between the AIGHL-LC and glenoid bone were significantly greater than without subscapularis loading (P < .01). We conclude that isometric contraction exercises of the subscapularis might facilitate healing of the AIGHL-LC after Bankart repair.     

Finite element modelling of the glenohumeral capsule can help assess the tested region during a clinical exam

The objective of this research was to examine the efficacy of evaluating the region of the glenohumeral capsule being tested by clinical exams for shoulder instability using finite element (FE) models of the glenohumeral joint. Specifically, the regions of high capsule strain produced by glenohumeral joint positions commonly used during a clinical exam were identified. Kinematics that simulated a simple translation test with an anterior load at three external rotation angles were applied to a validated, subject-specific FE model of the glenohumeral joint at 60° of abduction. Maximum principal strains on the glenoid side of the inferior glenohumeral ligament (IGHL) were significantly higher than the maximum principal strains on the humeral side, for all three regions of the IGHL at 30° and 60° of external rotation. These regions of localised strain indicate that these joint positions might be used to test the glenoid side of the IGHL during this clinical exam, but are not useful for assessing the humeral side of the IGHL. The use of FE models will facilitate the search for additional joint positions that isolate high strains to other IGHL regions, including the humeral side of the IGHL.     

Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study

Rotator cuff tear (RCT) in older adults may cause decreased muscle forces and disrupt the force balance at the glenohumeral joint, compromising joint stability. Our objective was to identify how increased RCT severity affects glenohumeral joint loading and muscle activation patterns using a computational model. Muscle volume measurements were used to scale a nominal upper limb model’s peak isometric muscle forces to represent force-generating characteristics of an average older adult male. Increased RCT severity was represented by systematically decreasing peak isometric muscle forces of supraspinatus, infraspinatus, and subscapularis. Five static postures in both scapular and frontal planes were evaluated. Results revealed that in both scapular and frontal planes, the peak glenohumeral joint contact force magnitude remained relatively consistent across increased RCT severity (average 1.5% and −4.2% change, respectively), and a relative balance of the transverse force couple is maintained even in massive RCT models. Predicted muscle activations of intact muscles, like teres minor, increased (average 5–30% and 4–17% in scapular and frontal planes, respectively) with greater RCT severity. This suggests that the system is prioritizing glenohumeral joint stability, even with severe RCT, and that unaffected muscles play a compensatory role to help stabilize the joint.     

Development and validation of a subject-specific moving-axis tibiofemoral joint model using MRI and EOS imaging during a quasi-static lunge

The aims of this study were to introduce and validate a novel computationally-efficient subject-specific tibiofemoral joint model. Subjects performed a quasi-static lunge while micro-dose radiation bi-planar X-rays (EOS Imaging, Paris, France) were captured at roughly 0°, 20°, 45°, 60°, and 90° of tibiofemoral flexion. Joint translations and rotations were extracted from this experimental data through 2D-to-3D bone reconstructions, using an iterative closest point optimization technique, and employed during model calibration and validation. Subject-specific moving-axis and hinge models for comparisons were constructed in the AnyBody Modeling System (AMS) from Magnetic Resonance Imaging (MRI)-extracted anatomical surfaces and compared against the experimental data. The tibiofemoral axis of the hinge model was defined between the epicondyles while the moving-axis model was defined based on two tibiofemoral flexion angles (0° and 90°) and the articulation modeled such that the tibiofemoral joint axis moved linearly between these two positions as a function of the tibiofemoral flexion. Outside this range, the joint axis was assumed to remain stationary. Overall, the secondary joint kinematics (ML: medial–lateral, AP: anterior-posterior, SI: superior-inferior, IE: internal-external, AA: adduction-abduction) were better approximated by the moving-axis model with mean differences and standard errors of (ML: −1.98 ± 0.37 mm, AP: 6.50 ± 0.82 mm, SI: 0.05 ± 0.20 mm, IE: 0.59 ± 0.36°, AA: 1.90 ± 0.79°) and higher coefficients of determination (R²) for each clinical measure. While the hinge model achieved mean differences and standard errors of (ML: −0.84 ± 0.45 mm, AP: 10.11 ± 0.88 mm, SI: 0.66 ± 0.62 mm, IE: −3.17 ± 0.86°, AA: 11.60 ± 1.51°).     

Effects of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: Finite element modeling of cadaver specimens

A novel technique of “anterior offsetting” of the humeral head component to address posterior instability in total shoulder arthroplasty has been proposed, and its biomechanical benefits have been previously demonstrated experimentally. The present study sought to characterize the changes in joint mechanics associated with anterior offsetting with various amounts of glenoid retroversion using cadaver specimen-specific 3-dimensional finite element models. Specimen-specific computational finite element models were developed through importing digitized locations of six musculotendinous units of the rotator cuff and deltoid muscles based off three cadaveric shoulder specimens implanted with total shoulder arthroplasty in either anatomic or anterior humeral head offset. Additional glenoid retroversion angles (0°, 10°, 20°, and 30°) other than each specimen׳s actual retroversion were modeled. Contact area, contact force, peak pressure, center of pressure, and humeral head displacement were calculated at each offset and retroversion for statistical analysis. Anterior offsetting was associated with significant anterior shift of center of pressure and humeral head displacement upon muscle loading (p<0.05). Although statistically insignificant, anterior offsetting was associated with increased contact area and decreased peak pressure (p > 0.05). All study variables showed significant differences when compared between the 4 different glenoid retroversion angles (p < 0.05) except for total force (p < 0.05). The study finding suggests that the anterior offsetting technique may contribute to joint stability in posteriorly unstable shoulder arthroplasty and may reduce eccentric loading on glenoid components although the long term clinical results are yet to be investigated in future.     

Contributions of the individual muscles of the shoulder to glenohumeral joint stability during abduction

The aim of this study was to determine the relative contributions of the deltoid and rotator cuff muscles to glenohumeral joint stability during arm abduction. A three-dimensional model of the upper limb was used to calculate the muscle and joint-contact forces at the shoulder for abduction in the scapular plane. The joints of the shoulder girdle-sternoclavicular joint, acromioclavicular joint, and glenohumeral joint-were each represented as an ideal three degree-of-freedom ball-and-socket joint. The articulation between the scapula and thorax was modeled using two kinematic constraints. Eighteen muscle bundles were used to represent the lines of action of 11 muscle groups spanning the glenohumeral joint. The three-dimensional positions of the clavicle, scapula, and humerus during abduction were measured using intracortical bone pins implanted into one subject. The measured bone positions were inputted into the model, and an optimization problem was solved to calculate the forces developed by the shoulder muscles for abduction in the scapular plane. The model calculations showed that the rotator cuff muscles (specifically, supraspinatus, subscapularis, and infraspinatus) by virtue of their lines of action are perfectly positioned to apply compressive load across the glenohumeral joint, and that these muscles contribute most significantly to shoulder joint stability during abduction. The middle deltoid provides most of the compressive force acting between the humeral head and the glenoid, but this muscle also creates most of the shear, and so its contribution to joint stability is less than that of any of the rotator cuff muscles.     

A musculoskeletal shoulder simulation of moment arms and joint reaction forces after medialization of the supraspinatus footprint in rotator cuff repair

A non-anatomical reinsertion of the supraspinatus medially to the original footprint to avoid over-tensioning of the tendon in large and retracted tears is one surgical option in rotator cuff (RC) repair. The purpose of the study was to determine the biomechanical effects on the glenohumeral joint with regard to this surgical technique. A modified musculoskeletal computational shoulder model was used to evaluate the change in moment arms and muscle forces of the RC and the co-contracting muscles and the alteration of the joint reaction forces (compressive and shear forces) after reinsertion of the supraspinatus 5?mm, 10?mm, 15?mm and 20?mm medially to the original footprint. A medialization of the supraspinatus reduces its moment arm in glenohumeral abduction. In case of a medialization of the attachment of 15?mm and 20?mm, the supraspinatus restricts glenohumeral abduction at 54° and 68°. In glenohumeral forward flexion and in lower degrees of internal rotation the moment arm of the supraspinatus increases for a medialized tendon attachment and decreases in external rotation in relation to the anatomical condition. A medialization of the supraspinatus insertion point yields in an increase in muscle force for abduction, internal and external rotation. In the present model a medially non-anatomic reinsertion reduces significantly the compressive glenohumeral joint reaction and the glenohumeral stability. Moreover, the results show that a medialization of the supraspinatus leads to a reduction of the supraspinatus moment arm especially in abduction. This leads to an increase of a compensatory supraspinatus load for stabilization the humerus in space, which may potentially cause a postoperative overload of the tendon-bone-complex.     

Digital fluoroscopic video assessment of glenohumeral migration: Static vs. Dynamic conditions

The purpose was to compare glenohumeral (GH) migration, during dynamic shoulder elevation and statically held positions using digital fluoroscopic videos (DFV). Thirty male volunteers (25±4 years) without right shoulder pathology were analyzed using DFV (30 Hz) during arm elevation in the scapular plane. DFV were obtained at the arm at side position, 45°, 90°, and 135° for static and dynamic conditions. GH migration was measured as the distance from the center of the humeral head migrated superiorly or inferiorly relative to the center of the glenoid fossa. Inter-rater reliability was considered good; ICC (2,3) ranged from 0.83 to 0.92. A main effect was revealed for contraction type (p=0.031), in which post-hoc t-tests revealed that humeral head was significantly more superior on the glenoid fossa during dynamic contraction. A main effect was also revealed for arm angle (p<0.001), in which post-hoc t-tests revealed significantly more superior humeral head positioning at 45°, 90°, and 135° when compared to arm at side (p<0.001), as well as at 90° compared to 45° (p=0.024). There was no interaction effect between angle and contraction type (p=0.400). Research utilizing static imaging may underestimate the amount of superior GH migration that occurs dynamically.     

Validation of imaging-based quantification of glenohumeral joint kinematics using an unmodified clinical biplane fluoroscopy system

Model-based tracking, using CT and biplane fluoroscopy, allows highly accurate quantification of glenohumeral motion and changes in the subacromial space. Previous investigators have used custom-built biplane fluoroscopes designed specifically for kinematic applications, which are available at few institutions and require FDA approval prior to clinical use. The aim of this study was to demonstrate the utility of an off-the-shelf clinical biplane fluoroscope for kinematic applications by validating model-based tracking for measurement of glenohumeral motion using an unmodified clinical system. Biplane images of each shoulder of a cadaver torso were acquired at various joint positions and during simulated movements along anatomical planes of motion. The pose of each humerus and scapula was determined using model-based tracking and compared to a bead-based gold standard. Error due to a temporal-offset between corresponding biplane images, characteristic of clinical biplane systems, was determined by comparison of measured and known relative position of 2 bead clusters of a phantom that was imaged while moved throughout the fluoroscopy image volume. Model-based tracking had global kinematic mean absolute errors of 0.27 mm and 0.29° (static), and 0.22–0.32 mm and 0.12–0.45° (dynamic). Glenohumeral mean absolute errors were 0.39 mm and 0.45° (static), and 0.36–0.42 mm and 0.41–0.48° (dynamic). The temporal-offset was predicted to add errors of 0.06–0.85 mm and 0.05–0.28° for cadaveric trials for the speeds examined. For defined speeds, sub-millimeter and sub-degree kinematic accuracy and precision were achieved using an unmodified clinical biplane fluoroscope for quantification of glenohumeral motion.     

Glenohumeral translation during active and passive elevation of the shoulder - a 3D open-MRI study

Despite its importance for the understanding of joint mechanics in healthy subjects and patients, there has been no three-dimensional (3D) in vivo data on the translation of the humeral head relative to the glenoid during abduction under controlled mechanical loading. The objective was therefore to analyze humeral head translation during passive and active elevation by applying an open MR technique and 3D digital postprocessing methods. Fifteen healthy volunteers were examined with an open MR system at different abduction positions under muscular relaxation (30-150 degrees of abduction) and during activity of shoulder muscles (60-120 degrees ). After segmentation and 3D reconstruction, the center of mass of the glenoid and the midpoint of the humeral head were determined and their relative position calculated. During passive elevation, the humeral head translated inferiorly from +1.58mm at 30 degrees to +0. 36mm at 150 degrees of abduction, and posteriorly from +1.55mm at 30 degrees to -0.07mm at 150 degrees of abduction. Muscular activity brought about significant changes in glenohumeral translation, the humeral head being in a more inferior position and more centered, particularly at 90 and 120 degrees of abduction (p<0.01). In anterior/posterior direction the humeral head was more centered at 60 and 90 degrees of abduction during muscle activity. The data demonstrate the importance of neuromuscular control in providing joint stability. The technique developed can also be used for investigating the effect of muscle dysfunction and their relevance on the mechanics of the shoulder joint.     

Finite element modelling of glenohumeral kinematics following total shoulder arthroplasty

Due to the shallowness of the glenohumeral joint, a challenging but essential requirement of a glenohumeral prosthesis is the prevention of joint dislocation. Weak glenoid bone stock and frequent dysfunction of the rotator cuff, both of which are common with rheumatoid arthritis, make it particularly difficult to achieve this design goal. Although a variety of prosthetic designs are commercially available only a few experimental studies have investigated the kinematics and dislocation characteristics of design variations. Analytical or numerical methods, which are predictive and more cost-effective, are, apart from simple rigid-body analyses, non-existent. The current investigation presents the results of a finite element analysis of the kinematics of a total shoulder joint validated using recently published experimental data for the same prostheses. The finite element model determined the loading required to dislocate the humeral head, and the corresponding translations, to within 4% of the experimental data. The finite element method compared dramatically better to the experimental data (mean difference=2.9%) than did rigid-body predictions (mean difference=37%). The goal of this study was to develop an accurate method that in future studies can be used for further investigations of the effect of design parameters on dislocation, particularly in the case of a dysfunctional rotator cuff. Inherently, the method also evaluates the glenoid fixation stresses in the relatively weak glenoid bone stock. Hence, design characteristics can be simultaneously optimised against dislocation as well as glenoid loosening.     

Wear in the prosthetic shoulder: association with design parameters

Total replacement of the glenohumeral joint provides an effective means for treating a variety of pathologies of the shoulder. However, several studies indicate that the procedure has not yet been entirely optimized. Loosening of the glenoid component remains the most likely cause of implant failure, and generally this is believed to stem from either mechanical failure of the fixation in response to high tensile stresses, or through osteolysis of the surrounding bone stock in response to particulate wear debris. Many computational studies have considered the potential for the former, although only few have attempted to tackle the latter. Using finite-element analysis an investigation, taking into account contact pressures as well as glenohumeral kinematics, has thus been conducted, to assess the potential for polyethylene wear within the artificial shoulder. The relationships between three different aspects of glenohumeral design and the potential for wear have been considered, these being conformity, polyethylene thickness, and fixation type. The results of the current study indicate that the use of conforming designs are likely to produce slightly elevated amounts of wear debris particles when compared with less conforming joints, but that the latter would be more likely to cause material failure of the polyethylene. The volume of wear debris predicted was highly influenced by the rate of loading, however qualitatively it was found that wear predictions were not influenced by the use of different polyethylene thicknesses nor fixation type while the depth of wearing was. With the thinnest polyethylene designs (2 mm) the maximum depth of the wear scar was seen to be upwards of 20% higher with a metal-backed fixation as opposed to a cemented design. In all-polyethylene designs peak polymethyl methacrylate tensile stresses were seen to reduce with increasing polyethylene thickness. Irrespective of the rate of loading of the shoulder joint, the current study indicates that it is possible to optimize glenoid component design against abrasive wear through the use of high conformity designs, possessing a polyethylene thickness of at least 6 mm.     

Static optimization underestimates antagonist muscle activity at the glenohumeral joint: A musculoskeletal modeling study

Static optimization is commonly employed in musculoskeletal modeling to estimate muscle and joint loading; however, the ability of this approach to predict antagonist muscle activity at the shoulder is poorly understood. Antagonist muscles, which contribute negatively to a net joint moment, are known to be important for maintaining glenohumeral joint stability. This study aimed to compare muscle and joint force predictions from a subject-specific neuromusculoskeletal model of the shoulder driven entirely by measured muscle electromyography (EMG) data with those from a musculoskeletal model employing static optimization. Four healthy adults performed six sub-maximal upper-limb contractions including shoulder abduction, adduction, flexion, extension, internal rotation and external rotation. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using both a calibrated EMG-driven neuromusculoskeletal modeling framework, and musculoskeletal model simulations that employed static optimization. The EMG-driven model predicted antagonistic muscle function for pectoralis major, latissimus dorsi and teres major during abduction and flexion; supraspinatus during adduction; middle deltoid during extension; and subscapularis, pectoralis major and latissimus dorsi during external rotation. In contrast, static optimization neural solutions showed little or no recruitment of these muscles, and preferentially activated agonistic prime movers with large moment arms. As a consequence, glenohumeral joint force calculations varied substantially between models. The findings suggest that static optimization may under-estimate the activity of muscle antagonists, and therefore, their contribution to glenohumeral joint stability.     

Sensitivity of intervertebral joint forces to center of rotation location and trends along its migration path

Translational vertebral motion during functional tasks manifests itself in dynamic loci for center of rotation (COR). A shift of COR affects moment arms of muscles and ligaments; consequently, muscle and joint forces are altered. Based on posture- and level-specific trends of COR migration revealed by in vivo dynamic radiography during functional activities, it was postulated that the instantaneous COR location for a particular joint is optimized in order to minimize the joint reaction forces. A musculoskeletal multi-body model was employed to investigate the hypotheses that (1) a posterior COR in upright standing and (2) an anterior COR in forward flexed posture leads to optimized lumbar joint loads. Moreover, it was hypothesized that (3) lower lumbar levels benefit from a more superiorly located COR.The COR in the model was varied from its initial position in posterior-anterior and inferior-superior direction up to ±6 mm in steps of 2 mm. Movement from upright standing to 45° forward bending and backwards was simulated for all configurations. Joint reaction forces were computed at levels L2L3 to L5S1. Results clearly confirmed hypotheses (1) and (2) and provided evidence for the validity of hypothesis (3), hence offering a biomechanical rationale behind the migration paths of CORs observed during functional flexion/extension movement. Average sensitivity of joint force magnitudes to an anterior shift of COR was +6 N/mm in upright and −21 N/mm in 30° forward flexed posture, while sensitivity to a superior shift in upright standing was +7 N/mm and −8 N/mm in 30° flexion. The relation between COR loci and joint loading in upright and flexed postures could be mainly attributed to altered muscle moment arms and consequences on muscle exertion. These findings are considered relevant for the interpretation of COR migration data, the development of numerical models, and could have an implication on clinical diagnosis and treatment or the development of spinal implants.     

Algorithm and validation of a computer method for quantifying attachment locus of glenohumeral ligament in vivo

The aim of this work is to validate an algorithm that quantifies the locus of glenohumeral ligament (GHL) attachments on glenohumeral joint (GHJ) bones.

A computed tomography scan of a GHJ was segmented to reconstruct the humerus, scapula, anatomical neck (AN) and glenoid rim (GR) into 3D meshes of interconnecting nodal vectors. These were applied to construct a ‘clock face’ coordinate system in which 3 o'clock points anteriorly.

Based on the assigned clock face coordinate frame and the fitted plane, the error between the fitted plane and the actual bony node was quantified through manual data extraction. This was tested on 50 specimens.

Mean algorithm quantification errors for GHL attachments were 4.8 (SD 2.2 mm) and 4.5 mm (1.7 mm) for the humerus and glenoid, respectively. Further studies would apply this to investigate GHL length changes during function and may suggest how these structures should be handled during surgical repairs.     

Finding consistent strain distributions in the glenohumeral capsule between two subjects: implications for development of physical examinations

The anterior-inferior glenohumeral capsule is the primary passive stabilizer to the glenohumeral joint during anterior dislocation. Physical examinations following dislocation are crucial for proper diagnosis of capsule pathology; however, they are not standardized for joint position which may lead to misdiagnoses and poor outcomes. To suggest joint positions for physical examinations where the stability provided by the capsule may be consistent among patients, the objective of this study was to evaluate the distribution of maximum principal strain on the anterior-inferior capsule using two validated subject-specific finite element models of the glenohumeral joint at clinically relevant joint positions. The joint positions with 25 N anterior load applied at 60° of glenohumeral abduction and 10°, 20°, 30° and 40° of external rotation resulted in distributions of strain that were similar between shoulders (r2 ≥ 0.7). Furthermore, those positions with 20-40° of external rotation resulted in capsule strains on the glenoid side of the anterior band of the inferior glenohumeral ligament that were significantly greater than in all other capsule regions. These findings suggest that anterior stability provided by the anterior-inferior capsule may be consistent among subjects at joint positions with 60° of glenohumeral abduction and a mid-range (20-40°) of external rotation, and that the glenoid side has the greatest contribution to stability at these joint positions. Therefore, it may be possible to establish standard joint positions for physical examinations that clinicians can use to effectively diagnose pathology in the anterior-inferior capsule following dislocation and lead to improved outcomes.     

The morphology and evolutionary history of the glenohumeral joint of hominoids: A review

The glenohumeral joint, the most mobile joint in the body of hominoids, is involved in the locomotion of all extant primates apart from humans. Over the last few decades, our knowledge of how variation in its morphological characteristics relates to different locomotor behaviors within extant primates has greatly improved, including features of the proximal humerus and the glenoid cavity of the scapula, as well as the muscles that function to move the joint (the rotator cuff muscles). The glenohumeral joint is a region with a strong morphofunctional signal, and hence, its study can shed light on the locomotor behaviors of crucial ancestral nodes in the evolutionary history of hominoids (e.g., the last common ancestor between humans and chimpanzees). Hominoids, in particular, are distinct in showing round and relatively big proximal humeri with lowered tubercles and flattened and oval glenoid cavities, morphology suited to engage in a wide range of motions, which enables the use of locomotor behaviors such as suspension. The comparison with extant taxa has enabled more informed functional interpretations of morphology in extinct primates, including hominoids, from the Early Miocene through to the emergence of hominins. Here, I review our current understanding of glenohumeral joint functional morphology and its evolution throughout the Miocene and Pleistocene, as well as highlighting the areas where a deeper study of this joint is still needed.     

Glenohumeral stability in simulated rotator cuff tears

Rotator cuff tears disrupt the force balance in the shoulder and the glenohumeral joint in particular, resulting in compromised arm elevation torques. The trade-off between glenohumeral torque and glenohumeral stability is not yet understood. We hypothesize that compensation of lost abduction torque will lead to a superior redirection of the reaction force vector onto the glenoid surface, which will require additional muscle forces to maintain glenohumeral stability. Muscle forces in a single arm position for five combinations of simulated cuff tears were estimated by inverse dynamic simulation (Delft Shoulder and Elbow Model) and compared with muscle forces in the non-injured condition. Each cuff tear condition was simulated both without and with an active modeling constraint for glenohumeral stability, which was defined as the condition in which the glenohumeral reaction force intersects the glenoid surface. For the simulated position an isolated tear of the supraspinatus only increased the effort of the other muscles with 8%, and did not introduce instability. For massive cuff tears beyond the supraspinatus, instability became a prominent factor: the deltoids were not able to fully compensate lost net abduction torque without introducing destabilizing forces; unfavorable abductor muscles (i.e. in the simulated position the subscapularis and the biceps longum) remain to compensate the necessary abduction torque; the teres minor appeared to be of vital importance to maintain glenohumeral stability. Adverse adductor muscle co-contraction is essential to preserve glenohumeral stability.     

Comparative assessment of knee joint models used in multi-body kinematics optimisation for soft tissue artefact compensation

Estimating joint kinematics from skin-marker trajectories recorded using stereophotogrammetry is complicated by soft tissue artefact (STA), an inexorable source of error. One solution is to use a bone pose estimator based on multi-body kinematics optimisation (MKO) embedding joint constraints to compensate for STA. However, there is some debate over the effectiveness of this method. The present study aimed to quantitatively assess the degree of agreement between reference (i.e., artefact-free) knee joint kinematics and the same kinematics estimated using MKO embedding six different knee joint models. The following motor tasks were assessed: level walking, hopping, cutting, running, sit-to-stand, and step-up. Reference knee kinematics was taken from pin-marker or biplane fluoroscopic data acquired concurrently with skin-marker data, made available by the respective authors. For each motor task, Bland-Altman analysis revealed that the performance of MKO varied according to the joint model used, with a wide discrepancy in results across degrees of freedom (DoFs), models and motor tasks (with a bias between −10.2° and 13.2° and between −10.2 mm and 7.2 mm, and with a confidence interval up to ±14.8° and ±11.1 mm, for rotation and displacement, respectively). It can be concluded that, while MKO might occasionally improve kinematics estimation, as implemented to date it does not represent a reliable solution to the STA issue.     

Algorithm and validation of a computer method for quantifying attachment locus of glenohumeral ligament in vivo

The aim of this work is to validate an algorithm that quantifies the locus of glenohumeral ligament (GHL) attachments on glenohumeral joint (GHJ) bones. A computed tomography scan of a GHJ was segmented to reconstruct the humerus, scapula, anatomical neck (AN) and glenoid rim (GR) into 3D meshes of interconnecting nodal vectors. These were applied to construct a 'clock face' coordinate system in which 3 o'clock points anteriorly. Based on the assigned clock face coordinate frame and the fitted plane, the error between the fitted plane and the actual bony node was quantified through manual data extraction. This was tested on 50 specimens. Mean algorithm quantification errors for GHL attachments were 4.8 (SD 2.2?mm) and 4.5?mm (1.7?mm) for the humerus and glenoid, respectively. Further studies would apply this to investigate GHL length changes during function and may suggest how these structures should be handled during surgical repairs.