Study of the Antipodal Capsular Fold and Its Potential Role in Antero-inferior Glenohumeral Instability

Study Overview
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Brief Summary
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In schoulders instabilty, the soft tissue has not been the subject of histological studies, as has the bare area or zone devoid of cartilage, the exact role of which in glenohumeral biomechanics is unknown. This research is based on the hypothesis that the antipodal lesions are constant, underestimated and that an architectural disorganization at the capsulo-ligament level could contribute to the instability of the shoulder. The aim of this study is therefore to better characterize these lesions which could be the subject of a complementary stabilization procedure even in the absence of a humeral notch

Detailed Description
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Surgery for unstable shoulders sometimes involves repairing lesions that promote instability. These lesions are identified on imaging before surgery and then during the operation, but they are macroscopically inconsistent on genuine unstable shoulders. While the importance of posterior capsuloligamentous structures (soft tissue) in antero-inferior stability has been the subject of biomechanical studies, the soft tissue has not been the subject of histological studies, as has the bare area or zone devoid of cartilage, the exact role of which in glenohumeral biomechanics is unknown. However, this research is based on the hypothesis that the antipodal lesions are constant, underestimated and that an architectural disorganization at the capsulo-ligament level could contribute to the instability of the shoulder. The aim of this study is therefore to better characterize these lesions which could be the subject of a complementary stabilization procedure even in the absence of a humeral notch.

Official Title
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Study of the Antipodal Capsular Fold and Its Potential Role in Antero-inferior Glenohumeral Instability - Instabio

Conditions
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Shoulder Capsulitis

Intervention / Treatment
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* Procedure: Biopsy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Instability Group Patient, male or female, over 18 years old and up to 40 years old Patient operated for antero-inferior shoulder instability Subject affiliated or beneficiary of a social security scheme Patient having signed the free and informed consent comparativ group Patient, male or female, over 18 years old and up to 40 years old Patient operated for a reason other than unstable shoulder Subject affiliated or beneficiary of a social security scheme Patient having signed the free and informed cons Exclusion Criteria: History of surgery on the affected shoulder Capsuloligamentous disease (Ehler Danlos) History of instability (dislocation, subluxation) in witnesses Patient participating in another clinical study Protected patient: adult under guardianship, curatorship or other legal protection, deprived of liberty by judicial or administrative decision; Pregnant, breastfeeding or parturient woman; Patient hospitalized without consent.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Instability shoulder group<br>Patients operated for an antero-inferior shoulder instability | Procedure: Biopsy<br>* The biopsy will be performed at the level of the capsular fold located just above the area devoid of cartilage in the postero-superior region of the humeral head, near the area where Hill Sachs notches occur.<br>|
| Other: Non instability shoulder group<br>Patients without shoulder instability, operated for another reason. | Procedure: Biopsy<br>* The biopsy will be performed at the level of the capsular fold located just above the area devoid of cartilage in the postero-superior region of the humeral head, near the area where Hill Sachs notches occur.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Capsule Aspect | Normal capsule versus pathological capsule (abnormal capsule with disorganized framework, fragmented fibers, coiled ) | during biopsy |