The impact of glenoid labrum thickness and modulus on labrum and glenohumeral capsule function.

The glenoid labrum is an integral component of the glenohumeral capsule's insertion into the glenoid, and changes in labrum geometry and mechanical properties may lead to the development of glenohumeral joint pathology. The objective of this research was to determine the effect that changes in labrum thickness and modulus have on strains in the labrum and glenohumeral capsule during a simulated physical examination for anterior instability. A labrum was incorporated into a validated, subject-specific finite element model of the glenohumeral joint, and experimental kinematics were applied simulating application of an anterior load at 0 deg, 30 deg, and 60 deg of external rotation and 60 deg of glenohumeral abduction. The radial thickness of the labrum was varied to simulate thinning tissue, and the tensile modulus of the labrum was varied to simulate degenerating tissue. At 60 deg of external rotation, a thinning labrum increased the average and peak strains in the labrum, particularly in the labrum regions of the axillary pouch (increased 10.5% average strain) and anterior band (increased 7.5% average strain). These results suggest a cause-and-effect relationship between age-related decreases in labrum thickness and increases in labrum pathology. A degenerating labrum also increased the average and peak strains in the labrum, particularly in the labrum regions of the axillary pouch (increased 15.5% strain) and anterior band (increased 10.4% strain). This supports the concept that age-related labrum pathology may result from tissue degeneration. This work suggests that a shift in capsule reparative techniques may be needed in order to include the labrum, especially as activity levels in the aging population continue to increase. In the future validated, finite element models of the glenohumeral joint can be used to explore the efficacy of new repair techniques for glenoid labrum pathology.