Arthroscopic Rotator Interval Repair in Glenohumeral Instability
abstract & commentary
Synopsis: Rotator interval plication can be performed and visualized arthroscopically for isolated cases of shoulder instability.
Source: Gartsman G, et al. Arthroscopic rotator interval repair in glenohumeral instability: Description of an operative technique. Arthroscopy 1999;15:330-333.
Gartsman and colleagues present a concise and straightforward technique for arthroscopic repair of rotator interval lesions. Their technique emphasizes a direct intra-articular visualization without entering the subacromial space. The advantage of this technique is purported to be intra-articular visualization of the repair. This differs from other arthroscopic rotator interval plication techniques that view the closure from the bursal surface through the subacromial space.
Comment by Stephen B. Gunther, MD
Shoulder instability is a multifactorial process of dysfunctional laxity that leads to one of several different clinical scenarios. The direction, chronicity, degree, volition, and mechanism of instability are a few of the important factors. The rotator interval is a triangular area between the supraspiatus and subscapularis tendons that contains the superior glenohumeral ligament and the coracohumeral ligament. Warner and colleagues1 and Harryman and associates2 performed anatomic, cadaver studies that elucidated the importance of the rotator interval in providing static shoulder stability in positions of flexion, extension, and adduction with external rotation.
Rotator interval plication is a standard adjunct to capsular shift procedures for anterior-inferior instability if a rotator interval defect is present. However, the role of isolated rotator interval plication as a shoulder stabilization procedure is controversial. While Gartsman et al describe a technique for arthroscopic rotator interval plication, its value as a stand-alone procedure is unknown.
References
1. Warner JJP, et al. Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint. Am J Sports Med 1992;19:675-685.
2. Harryman DT, et al. The role of the interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am 1992;74:53-66.
40. The rotator interval contains the:
a. infraspinatus tendon.
b. superior glenohumeral ligament.
c. inferior glenohumeral ligament.
d. glenoid labrum.
41. The osseous structure that is the most relevant in producing the classic shoulder impingement syndrome is the:
a. lateral acromium.
b. anterior acromium.
c. acromioclavicular joint.
d. greater tuberosity.
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