Effects of biceps tension on the torn superior glenoid labrum.

The purpose of this study was to evaluate the role of the tension on the long head of the biceps tendon in the propagation of SLAP tears by studying the mechanical behavior of the torn superior glenoid labrum. A previously validated finite element model was extended to include a glenoid labrum with type II SLAP tears of three different sizes. The strain distribution within the torn labral tissue with loading applied to the biceps tendon was investigated and compared to the inact and unloaded conditions. The anterior and posterior edges of each SLAP tear experienced the highest strain in the labrum. Labral strain increased with increasing biceps tension. This effect was stronger in the labrum when the size of the tear exceeded the width of the biceps anchor on the superior labrum. Thus, this study indicates that biceps tension influences the propagation of a SLAP tear more than it does the initiation of a tear. Additionally, it also suggests that the tear size greater than the biceps anchor site as a criterion in determining optimal treatment of a type II SLAP tear.

Effects of biceps tension and superior humeral head translation on the glenoid labrum.

We sought to understand the effects of superior humeral head translation and load of the long head of biceps on the pathomechanics of the superior glenoid labrum by predicting labral strain. Using micro-CT cadaver images, a finite element model of the glenohumeral joint was generated, consisting of humerus, glenoid bone, cartilages, labrum, and biceps tendon. A glenohumeral compression of 50 N and biceps tensions of 0, 22, 55, and 88 N were applied. The humeral head was superiorly translated from 0 to 5 mm in 1-mm increments. The highest labral strain occurred at the interface with the glenoid cartilage and bone beneath the origin of the biceps tendon. The maximum strain was lower than the reported failure strain. The humeral head motion had relatively greater effect than biceps tension on the increasing labral strain. This supports the mechanistic hypothesis that superior labral lesions result mainly from superior migration of the humeral head, but also from biceps tension

Shoulder labral pathomechanics with rotator cuff tears.

Rotator cuff tears (RCTs), the most common injury of the shoulder, are often accompanied by tears in the superior glenoid labrum. We evaluated whether superior humeral head (HH) motion secondary to RCTs and loading of the long head of the biceps tendon (LHBT) are implicated in the development of this associated superior labral pathology. Additionally, we determined the efficacy of a finite element model (FEM) for predicting the mechanics of the labrum. The HH was oriented at 30° of glenohumeral abduction and neutral rotation with 50N compressive force. Loads of 0N or 22N were applied to the LHBT. The HH was translated superiorly by 5mm to simulate superior instability caused by RCTs. Superior displacement of the labrum was affected by translation of the HH (P<0.0001), position along the labrum (P<0.0001), and interaction between the location on the labrum and LHBT tension (P<0.05). The displacements predicted by the FEM were compared with mechanical tests from 6 cadaveric specimens and all were within 1 SD of the mean. A hyperelastic constitutive law for the labrum was a better predictor of labral behavior than the elastic law and insensitive to ±1 SD variations in material properties. Peak strains were observed at the glenoid-labrum interface below the LHBT attachment consistent with the common location of labral pathology. These results suggest that pathomechanics of the shoulder secondary to RCTs (e.g., superior HH translation) and LHBT loading play significant roles in the pathologic changes seen in the superior labrum.

The relationship between anterior tibial acceleration, tibial slope, and ACL strain during a simulated jump landing task.

BACKGROUND: Knee joint morphology contributions to anterior cruciate ligament (ACL) loading are rarely considered in the injury prevention model. This may be problematic as the knee mechanical response may be influenced by these underlying morphological factors. The goal of the present study was to explore the relationship between posterior tibial slope (which has been recently postulated to influence knee and ACL loading), impact-induced anterior tibial acceleration, and resultant ACL strain during a simulated single-leg landing. METHODS: Eleven lower limb cadaveric specimens from female donors who had had a mean age (and standard deviation) of 65 ± 10.5 years at the time of death were mounted in a testing apparatus to simulate single-limb landings in the presence of pre-impact knee muscle forces. After preconditioning, specimens underwent five impact trials (mean impact force, 1297.9 ± 210.6 N) while synchronous three-dimensional joint kinetics, kinematics, and relative anteromedial bundle strain data were recorded. Mean peak tibial acceleration and anteromedial bundle strain were quantified over the first 200 ms after impact. These values, along with radiographically defined posterior tibial slope measurements, were submitted to individual and stepwise linear regression analyses. RESULTS: The mean peak anteromedial bundle strain (3.35% ± 1.71%) was significantly correlated (r = 0.79; p = 0.004; ß = 0.791) with anterior tibial acceleration (8.31 ± 2.77 m/s-2), with the times to respective peaks (66 ± 7 ms and 66 ± 4 ms) also being significantly correlated (r = 0.82; p = 0.001; ß = 0.818). Posterior tibial slope (mean, 7.6° ± 2.1°) was significantly correlated with both peak anterior tibial acceleration (r = 0.75; p = 0.004; ß = 0.786) and peak anteromedial bundle strain (r = 0.76; p = 0.007; ß = 0.759). CONCLUSIONS: Impact-induced ACL strain is directly proportional to anterior tibial acceleration, with this relationship being moderately dependent on the posterior slope of the tibial plateau.

Non-uniform distribution of strain during stretch of relaxed skeletal muscle fibers from rat soleus muscle.

Tension and regional average sarcomere length (L(s)) behavior were examined during repeated stretches of single, permeabilized, relaxed muscle fibers isolated from the soleus muscles of rats. We tested the hypothesis that during stretches of single permeabilized fibers, the global fiber strain is distributed non-uniformly along the length of a relaxed fiber in a repeatable pattern. Each fiber was subjected to eight constant-velocity stretch and release cycles with a strain of 32% and strain rate of 54% s(-1). Stretch-release cycles were separated by a 4.5 min interval. Throughout each stretch-release cycle, sarcomere lengths were measured using a laser diffraction technique in which 20 contiguous sectors along the entire length of a fiber segment were scanned within 2 ms. The results revealed that: (1) the imposed length change was not distributed uniformly along the fiber, (2) the first stretch-release cycle differed from subsequent cycles in passive tension and in the distribution of global fiber strain, and (3) a characteristic "signature" for the L(s) response emerged after cycle 3. The findings support the conclusions that longitudinal heterogeneity exists in the passive stiffness of individual muscle fibers and that preconditioning of fibers with stretch-release cycles produces a stable pattern of sarcomere strains.

Lateral transmission of force is impaired in skeletal muscles of dystrophic mice and very old rats.

The dystrophin­glycoprotein complex (DGC) provides an essential link from the muscle fibre cytoskeleton to the extracellular matrix. In dystrophic humans and mdx mice, mutations in the dystrophin gene disrupt the structure of the DGC causing severe damage to muscle fibres. In frog muscles, transmission of force laterally from an activated fibre to the muscle surface occurs without attenuation, but lateral transmission of force has not been demonstrated in mammalian muscles. A unique 'yoke' apparatus was developed that attached to the epimysium of muscles midway between the tendons and enabled the measurement of lateral force. We now report that in muscles of young wild-type (WT) mice and rats, compared over a wide range of longitudinal forces, forces transmitted laterally showed little or no decrement. In contrast, for muscles of mdx mice and very old rats, forces transmitted laterally were impaired severely. Muscles of both mdx mice and very old rats showed major reductions in the expression of dystrophin. We conclude that during contractions, forces developed by skeletal muscles of young WT mice and rats are transmitted laterally from fibre to fibre through the DGC without decrement. In contrast, in muscles of dystrophic or very old animals, disruptions in DGC structure and function impair lateral transmission of force causing instability and increased susceptibility of fibres to contraction-induced injury.

Development and validation of a finite element model of the superior glenoid labrum.

Pathology of the superior glenoid labrum is a common source of musculoskeletal pain and disability. One of the proposed mechanisms of injury to the labrum is superior humeral head migration, which can be seen with rotator cuff insufficiency. Due to the size, anatomical location, and complex composition of the labrum, laboratory experiments have many methodological difficulties. The purpose of this study was to develop and validate a finite element model of the glenoid labrum. The model developed includes the glenoid labrum, glenoid cartilage, glenoid bone, and the humeral head cartilage. Labral displacements derived from the finite element model were compared to those measured during a controlled validation experiment simulating superior humeral head translations of 1, 2, and 3 mm. The results of the finite element model compared well to experimental measurements, falling within one standard deviation of the experimental data in most cases. The model predicted maximum average strains in the superior labrum of 7.9, 10.1, and 11.9%, for 1, 2, and 3 mm of humeral translation, respectively. The correspondence between the finite element model and the validation experiment supports the use of this model to better understand the pathomechanics of the superior labrum.

Magnitude of sarcomere extension correlates with initial sarcomere length during lengthening of activated single fibers from soleus muscle of rats.

A laser-diffraction technique was developed that rapidly reports the lengths of sarcomeres (L(s)) in serially connected sectors of permeabilized single fibers. The apparatus translates a laser beam along the entire length of a fiber segment within 2 ms, with brief stops at each of 20 contiguous sectors. We tested the hypothesis that during lengthening contractions, when maximally activated fibers are stretched, sectors that contain the longer sarcomeres undergo greater increases in L(s) than those containing shorter sarcomeres. Fibers (n = 16) were obtained from the soleus muscles of adult male rats and the middle portions (length = 1.05 +/- 0.11 mm; mean +/- SD) were investigated. Single stretches of strain 27% and a strain rate of 54% s(-1) were initiated at maximum isometric stress and resulted in a 19 +/- 9% loss in isometric stress. The data on L(s) revealed that 1), the stretch was not distributed uniformly among the sectors, and 2), during the stretch, sectors at long L(s) before the stretch elongated more than those at short lengths. The findings support the hypothesis that during stretches of maximally activated skeletal muscles, sarcomeres at longer lengths are more susceptible to damage by excessive strain.