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Arthroscopic release of the rotator interval and coracohumeral ligament: An anatomic study in cadavers
A Marc Tetro1, Gregory Bauer, Steven B Hollstien
1Department of Orthopaedic Surgery, The State University of New York at Buffalo, New York, USA.
Purpose:
The purpose of this cadaveric study was to examine the anatomy of the normal glenohumeral joint relevant to an arthroscopic rotator interval release and define both the endpoints of a complete release of the coracohumeral ligament and the relationship to surrounding tendons and nerves.
Type Of Study:
An anatomic cadaveric study.
Methods:
Fifteen fresh-frozen cadaveric specimens were studied with 5 specimens in group I and 10 specimens in group II. Group I specimens were used to examine the relevant anatomy, including the structures at risk, the dimensions of the rotator interval, and potential endpoints for release of the coracohumeral ligament. Measurements included (1) the supraspinatus to the subscapularis distance, (2) the distance from the rotator interval to the deep surface of the coracoid process, and (3) the distance from the rotator interval to the coracoacromial ligament at the level of the glenoid. Group II specimens underwent arthroscopic release of the rotator interval using the appearance of the coracoacromial ligament as the superficial endpoint. Dissection was then performed to examine for complete release of the coracohumeral ligament and to assess the structures at risk of injury.
Results:
The distance from the anterior edge of supraspinatus to the superior edge of subscapularis at the glenoid rim was 21.6 mm, which increased to 27.8 mm with joint distention. The minimum distance from the rotator interval to the deep surface of the coracoid process was 11.4 mm. Before distention, the coracoacromial ligament was an average of 6.2 mm from the rotator interval capsule. Arthroscopic release from the supraspinatus to the subscapularis resulted in complete resection of the coracohumeral ligament in all 15 specimens. There were no specimens with evidence of injury to the biceps tendon, supraspinatus, subscapularis, or the conjoint tendon.
Conclusions:
This study confirms that intra-articularly directed arthroscopic release of the rotator interval can safely lead to complete release of the coracohumeral ligament if dissection is taken superficially to the level of the coracoacromial ligament.