Changes to the mechanical properties of the glenohumeral capsule during anterior dislocation

The glenohumeral joint is the most frequently dislocated major joint in the body, and instability due to permanent deformation of the glenohumeral capsule is a common pathology. The corresponding change in mechanical properties may have implications for the ideal location and extent of plication, which is a common clinical procedure used to repair the capsule. Therefore, the objective of this study was to quantify the mechanical properties of four regions of the glenohumeral capsule after anterior dislocation and compare the properties to the normal glenohumeral capsule. Six fresh-frozen cadaveric shoulders were dislocated in the anterior direction with the joint in the apprehension position using a robotic testing system. After dislocation, mechanical testing was performed on the injured glenohumeral capsule by loading the tissue samples in tension and shear. An inverse finite element optimization routine was used to simulate the experiments and obtain material coefficients for each tissue sample. Cauchy stress-stretch curves were then generated to represent the mechanical response of each tissue sample to theoretical loading conditions. Based on several comparisons (average of the material coefficients, average stress-stretch curve for each region, and coefficients representing the average curves) between the normal and injured tissue samples, the mechanical properties of the injured tissue samples from multiple regions were found to be lower than those of the normal tissue in tension but not in shear. This finding indicates that anterior dislocation primarily affects the tensile behavior of the glenohumeral capsule rather than the shear behavior, and this phenomenon could be caused by plastic deformation of the matrix, permanent collagen fiber rotation, and/or collagen fiber failure. These results suggest that plication and suturing may not be sufficient to return stability to the shoulder after dislocation in all individuals. Thus, surgeons may need to perform a procedure that reinforces or stiffens the tissue itself, such as reconstruction or augmentation, to improve repair procedures.