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Soft Tissue Aspects of the Shoulder Joint
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to study different aspects of the soft tissues of the shoulder joint. The variation in the quality of the tendons and ligaments can be explained by genetic factors. To test the hypothesis that collagen 1 α1 Sp1 polymorphism is related to the occurrence of cruciate ligament ruptures and shoulder dislocations, a total of 358 patients (233 patients with cruciate ligament ruptures and 126 with shoulder dislocations) were included in the study. We found a decreased risk of these injuries associated with collagen type 1 α1 Sp1 polymorphism.

To study the mechanical properties of a better type of fixation of soft tissue to bone, 10 skeletally mature New Zealand white rabbits were operated bilaterally on the knees. The medial collateral ligaments were fixed by two types of plates one with a flat undersurface and the other with a pegged undersurface. After 4 weeks the force at failure, stiffness and energy uptake was almost double in the knees operated with the pegged plates.

The prevalence and dysfunction of rotator cuff tears was investigated in 106 subjects who had never sought for their shoulder complaints, using Constant score, ultrasound and plain x-ray. The prevalence of full-thickness cuff tears was 30% (21% of all shoulders). The Constant score was lower in subjects with full-thickness tears. Partial-thickness tears and acromioclavicular joint osteoarthritis had no impact on shoulder complaints or Constant score. The subacromial index was lower for shoulders with full-thickness tears.

Forty-eight patients with median age 56 years underwent subacromial decompression with or without acromioclavicular joint resection, investigated with MRI pre- and 3 months postoperatively. The Constant score and subjective shoulder value were measured preoperatively and at 3 and 6 months after surgery and even 2 years for subjective shoulder value. Two raters investigated the MRI. The results showed poor inter-rater reliability for MRI. However, both Constant score and subjective shoulder value improved over time. MRI is not a reliable method to study the capsular reaction after subacromial decompression due to high subjectivity of the radiologists.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 743
Keyword [en]
cruciate ligament, shoulder dislocation, polymorphism, collagen, biomechanical properties, rotator cuff tear, shoulder ultrasound, adhesive capsulitis, MRI
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:uu:diva-168236ISBN: 978-91-554-8278-7 (print)OAI: oai:DiVA.org:uu-168236DiVA: diva2:491561
Public defence
2012-03-30, Rosénsalen, Barnsjukhuset Ingång 95/96, Akademiska Sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-03-09 Created: 2012-02-06 Last updated: 2012-03-29Bibliographically approved
List of papers
1. Type I collagen alpha1 Sp1 polymorphism and the risk of cruciate ligament ruptures or shoulder dislocations
Open this publication in new window or tab >>Type I collagen alpha1 Sp1 polymorphism and the risk of cruciate ligament ruptures or shoulder dislocations
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2008 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 36, no 12, 2432-2436 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cruciate ligament ruptures and shoulder dislocations are often caused by trauma, but predisposing intrinsic factors might also influence the risk. These injuries are more common in those with a previously injured sibling, an observation that might indicate a genetic predisposition. It is well known that polymorphisms in the collagen I gene are associated not only with osteoporosis and osteoporotic fracture risk, but also with osteoarthritis.

HYPOTHESIS: Because collagen I is abundant in ligaments and tendons, the authors hypothesized that collagen I alpha1 Sp1 polymorphism also was related to the occurrence of cruciate ligament ruptures and shoulder dislocations.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: A total of 358 patients and 325 randomly selected population-based female controls were included in the study. Of the cases, 233 had a cruciate ligament rupture and 126 had had a shoulder dislocation. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) estimated by unconditional logistic regression were used as measures of association.

RESULTS: Compared with the homozygous SS category, the heterozygous participants displayed a similar risk (OR, 1.06; 95% CI, 0.76-1.49), whereas the ss genotype was underrepresented in the injured population compared with the controls (OR, 0.15; 95% CI, 0.03-0.68). This latter estimate was similar for both cruciate ligament ruptures and shoulder dislocations, and was furthermore not modified by general joint laxity.

CONCLUSION: The authors found a substantially decreased risk of these injuries associated with collagen type I alpha1 Sp1 polymorphism. The study might encourage other investigators to consider further research in the area of genes and soft tissue injuries.

Keyword
cruciate ligament rupture, shoulder dislocation, polymorphism, gene, collagen
National Category
Medical and Health Sciences Surgery
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-98661 (URN)10.1177/0363546508320805 (DOI)000261619200019 ()18669982 (PubMedID)
Available from: 2009-03-02 Created: 2009-03-02 Last updated: 2017-12-13Bibliographically approved
2. Improved healing of ligament to bone with point fixation in rabbits
Open this publication in new window or tab >>Improved healing of ligament to bone with point fixation in rabbits
2006 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 77, no 6, 967-972 p.Article in journal (Refereed) Published
Abstract [en]

Background Secure healing of soft tissue to bone is a prerequisite for many orthopedic operations. This healing can be achieved either by pressing the tissue against the bone (press fixation) or by suturing the soft tissue to the bone (point fixation). Experiments and findings We tested the hypothesis that point fixation of soft tissue to bone results in better mechanical properties than press fixation. 10 skeletally mature New Zealand White rabbits were operated on bilaterally at the knees. The medial collateral ligaments were fixated to the bone just above the original insertion on the tibia. Two types of plates were used for this purpose, one with flat undersurface (left knee) and the other one with a pegged undersurface (right knee). The pegged plate was thought to mimic fixation achieved with suture anchors. After 4 weeks, mechanical testing revealed an almost doubled force at failure, stiffness and energy uptake in the knees operated with the pegged plates. Interpretation Suture anchors or devices with a pegged undersurface are better for soft tissue fixation to bone than devices with a flat surface, such as screws with washers or staples.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-146492 (URN)10.1080/17453670610013303 (DOI)000243586300021 ()17260209 (PubMedID)
Available from: 2011-02-17 Created: 2011-02-17 Last updated: 2017-12-11Bibliographically approved
3. High prevalence of rotator cuff tears ina population who never sought for shoulder problems: a clinical, ultrasonographic and radiographic screening study
Open this publication in new window or tab >>High prevalence of rotator cuff tears ina population who never sought for shoulder problems: a clinical, ultrasonographic and radiographic screening study
Show others...
2012 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500Article in journal (Refereed) Submitted
National Category
Orthopedics
Identifiers
urn:nbn:se:uu:diva-167682 (URN)
Available from: 2012-02-06 Created: 2012-01-31 Last updated: 2017-12-08Bibliographically approved
4. MRI without contrast is an unreliable method for detection of capsular reaction following shoulder surgery
Open this publication in new window or tab >>MRI without contrast is an unreliable method for detection of capsular reaction following shoulder surgery
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2012 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455Article in journal (Refereed) Submitted
Abstract [en]

Background

Subacromial decompression is a common surgical procedure in patients with subacromial outlet impingement. The results are often good, although some patients develop adhesive capsulitis with postoperative pain and stiffness. The main aim of the present study was to analyze the reaction of the joint capsule 3 months after subacromial decompression using MRI without contrast.  We also wanted to study if there was a relation between the capsular reaction and the Constant score (CS) or the subjective shoulder value (SSV).

Methods

Forty-eight patients with a median age of fifty-six years underwent subacromial decompression with or without AC-joint resection. They were investigated with a standard x ray and MRI pre surgery and MRI three months after surgery. The CS and SSV were measured preoperatively and at three months, six months, and two years postoperatively for SSV. Two musculoskeletal radiologists independently evaluated the MRI images and used a scoring system from 0-7.

Results

The relationship between the baseline CS and the MRI pre-surgery score was significant for both raters. There were a significant difference between the raters’ pre and post-surgery average MRI scores, which simply means that there was a difference found in the average score between baseline and three months. However, the inter-rater reliability was poor. The improvement in the CS from baseline to three and six months postoperation was significant. The subjective shoulder value improved at three, six and 24 months after surgery.

Conclusions

MRI is an unreliable method to study capsular reaction in the shoulder joint due to the high subjectivity of the radiologists. Considerable improvements were observed in the CS and the SSV.

National Category
Orthopedics
Identifiers
urn:nbn:se:uu:diva-167686 (URN)
Available from: 2012-02-07 Created: 2012-01-31 Last updated: 2017-12-08Bibliographically approved

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