Abstract
Objectives:
The Rotator Cuff (RC) is formed from the subscapularis, supraspinatus, infraspinatus, and teres minor muscles and their tendinous extensions. The 4 RC tendons insert on the humeral head such that they contribute to the dynamic stability of the glenohumeral joint along with their rotational actions on the shoulder. The moment arm can be used to demonstrate the work effort potential that a specific muscle is contributing to a musculoskeletal joint rotation. The objective of this study was to break out RC muscles into multiple fibers, providing more clarity as to how individual fibers contribute to a muscle’s overall moment arm during abduction.
The aims of this study are: 1.) to illustrate within each RC muscle how multiple muscle fiber lines of action work together to produce abduction in an intact shoulder 2.) to estimate the moment arm changes that take place when the intact rotator cuff goes through surgical repair with either SCR or RSA after complete supraspinatus tear. We hypothesized that the rotator cuff muscles work differently and in combination at the fiber level to bring about a resultant movement that can be assessed through the proposed method of moment arm calculation for intact RC, complete supraspinatus tear, SCR and RSA.
Methods:
Five fresh cadaveric shoulder specimens were used in an apparatus where each muscle was maintained in tension with the line of action towards its origin on the scapula (Figure 1). An Optotrack camera kept track of digitized points along both the origin and insertion of the rotator cuff muscles as the shoulder was abducted. Using these digitized points, multiple lines of action were created across the breadth of each muscle. Each muscle force action line was then used to calculate moment arm values during 0-90º abduction (Figure 2).
Results:
Moment arms calculated for multiple fiber lines spanning the tendon attachment site displayed the variance of fiber contribution and function within each muscle during abduction. Our results indicate that rather than providing a return to anatomical shoulder muscle function, RSA and SCR models produce moment arms that vary between muscles, with some contributing more to abduction and some contributing less. Highlighted below are the infraspinatus results for moment arms of individual fiber lines of action (Figure 3) and calculated mean moment arms (Figure 4) over abduction.ANOVA testing demonstrated a significant difference (p<0.001) when analyzing moment arms of intact, complete supraspinatus tear, SCR, and RSA models in teres minor and infraspinatus. There was no significant difference in moment arm values between the models in the subscapularis (p=0.148). Highlighted in Table 1 are the ANOVA testing results for infraspinatus.
Conclusions:
Our biomechanical analysis demonstrated sufficient sensitivity to detect differences in moment arms of the four rotator cuff muscles across a variety of models, suggesting changes to even one muscle of the shoulder will have significant implications on the function of other shoulder muscles. Furthermore, our analysis of fiber divisions within the same muscle illustrates the complex nature of the shoulder muscles themselves, and future studies should aim to better explore and model their function. The calculated percent differences from intact beautifully illustrated this complexity, as corrective RSA and SCR procedures provided better resemblance of intact anatomy within some rotator cuff muscles while creating a larger percent difference in other muscle groups.
By breaking out RC muscles into multiple fibers, more clarity can be gained as to how individual fibers contribute to a muscle’s overall moment arm during abduction. This may further aid surgical decision-making, specifically for RSA where there is continued debate about whether to reconstruct portions of the RC. Given that the supraspinatus tendon is the most frequently torn tendon in the rotator cuff, especially for athletes who apply repetitive stress to the tendon, the results of this study may help inform post-operative rehabilitation by illustrating how abduction and stability are achieved after SCR and RSA.