Dataset Information

The Angular Relationships Between the Coracohumeral Ligament and Adjacent Shoulder Structures Are Variable.

ABSTRACT:

Purpose

To describe the arthroscopic anatomy of the coracohumeral ligament (CHL) in relation to visible anatomic reference points to aid in the execution of a more effective arthroscopic medial-lateral rotator interval closure.

Methods

Detailed dissection to identify the CHL was performed in 4 shoulders from 2 fresh-frozen donor cadavers with a deltopectoral approach. The angular relationship between the CHL and the superior border of the subscapularis tendon was determined via gross dissection. Arthroscopic images were used to determine the angular position of the CHL in relation to both the glenoid articular surface and the intraarticular segment of the tendon of the long head of the biceps brachii (LHB).

Results

Analysis of 4 cadaveric shoulders via gross dissection demonstrated the CHL to subtend a mean angle of 29° (range 16° to 39°) with respect to the superior border of the subscapularis tendon. Arthroscopic analysis of 4 cadaveric shoulders demonstrated the CHL to subtend a mean angle of 59° (range 38° to 77°) with respect to the glenoid articular surface. Additionally, arthroscopic analysis of 2 cadaveric shoulders demonstrated the CHL to subtend a mean angle of 29° (range 11° to 47°) with respect to the LHB tendon.

Conclusion

Although the position of the CHL in relation to the subscapularis tendon, glenoid articular surface, and LHB tendon demonstrates a moderate degree of anatomic variability, these structures provide valuable anatomic reference points for the identification of the course of this significant static shoulder stabilizer.

Clinical relevance

Comprehensive understanding of the angular relationships between the CHL and adjacent shoulder structures may assist with the execution of a more effective arthroscopic rotator interval closure.

SUBMITTER: Parisien RL

PROVIDER: S-EPMC8129431 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeThe purpose of this morphologic cadaveric study was to quantitatively define the composition of the previously described comma tissue along with its relation to the subscapularis tendon insertion.MethodsFresh frozen cadaveric shoulder specimens were included for analysis. The coracohumeral ligament (CHL) was exposed at its origin along the base of the coracoid process and freed laterally along its course to the lesser tuberosity adjacent to the bicipital groove. The superior glenohumeral ligament (SGHL) was identified and traced along its course deep to the CHL within the rotator interval with insertion onto the superior aspect of the lesser tuberosity. The midpoint diameters of the SGHL and CHL and their composite insertional diameters on the subscapularis tendon insertion and lesser tuberosity were measured with digital calipers. The mean diameter was determined from 3 measurements taken of each ligament.ResultsEight specimens were included. With the use of digital calipers, the mean midpoint diameters of the SGHL and CHL were identified as 5.99 mm (range, 5.25-6.91 mm) and 5.13 mm (range, 4.28-5.72 mm), respectively. The composite insertional diameter of the SGHL and CHL on both the lesser tuberosity and humeral insertion of the subscapularis tendon was 9.93 mm (range, 6.69-12.05 mm). At its insertion, the SGHL and CHL comprised 54% and 46% of the comma tissue, respectively. Additionally, all specimens were identified as showing a confluence of the SGHL and CHL composite insertion with the subscapularis tendon at the point of its humeral head insertion.ConclusionsThe comma tissue is a pivotal structure for the identification, mobilization, and repair of retracted subscapularis tendon tears. Therefore, quantitative knowledge of the midpoint diameter, insertional diameter, and composite distribution of the CHL and SGHL provided by this morphologic cadaveric analysis may aid surgeons in their efforts to restore the native anatomy.Clinical relevanceSubscapularis tendon tears have often been under-addressed during rotator cuff repair. The comma tissue has been described as an anatomic structure that can aid in the identification, mobilization, and repair of retracted subscapularis tendon tears. Therefore, quantitative knowledge of this important arthroscopic landmark may aid surgeons in their efforts to restore the native anatomy.