Dynamic capsuloligamentous anatomy of the glenohumeral joint

Though many anatomic and biomechanical studies have been performed to elucidate capsuloligamentous anatomy of the glenohumeral joint, no previous studies have evaluated capsuloligamentous anatomy during rotator cuff contraction. The purpose of this study was to define and document the orientation and interrelationship between the glenohumeral ligaments during simulated rotator cuff contraction. Six fresh cadaveric shoulders were arthroscoped to document and grade ligamentous anatomy. The superior and middle glenohumeral ligaments and the anterior and posterior bands of the inferior glenohumeral ligament complex were labeled by an arthroscopicassisted technique with a linked metallic bead system. Shoulders were then placed onto an experimental apparatus that simulated rotator cuff function through computer-controlled servo-hydrolic actuators attached to the rotator cuff and biceps by a clamp and cable-and-pulley system. Simulated rotator cuff action and manual placement allowed shoulders to be placed into three positions of rotation (neutral, internal, and external) in three positions of scapular plane abduction (0°, 45°, 90°). Anteroposterior and axillary lateral plane radiographs were taken in each position to document orientation of all four ligaments. Both the superior and middle glenohumeral ligaments were maximally lengthened in 0° and 45° abduction and external rotation and appeared to shorten in all positions of abduction. The anterior and posterior bands of the inferior glenohumeral ligament complex maintained a cruciate orientation in all positions of abduction in the anteroposterior plane, except at 90° abduction and external rotation, where they are parallel. This cruciate orientation is due to the different location of the glenoid origin and humeral insertion of each band and may allow reciprocal tightening of each during rotation. The glenohumeral capsule is composed of discreet ligaments that undergo large charges in orientation during rotation. The superior and middle glenohumeral ligaments appear to complement the inferior glenohumeral ligaments, with the former tightening in adduction and the latter tightening in abduction. This relationship permits the large range of motion normally seen in the glenohumeral joint.