Rotator interval dimensions in different shoulder arthroscopy positions: A cadaveric study

The rotator interval was defined as a triangular structure, where the base of the triangle was the coracoid base, the upper border was the anterior margin of the supraspinatus, and the lower border was the superior margin of the subscapularis muscle-tendon unit. We evaluated the rotator interval dimensions in 15 shoulders from 10 lightly embalmed adult cadavers in 3 shoulder arthroscopy positions: 0° of abduction and 30° of flexion (beach chair [BC]), 45° of abduction and 30° of flexion (lateral decubitus 1), and 70° of abduction and 30° of flexion (lateral decubitus 2). In each shoulder position, measurements were made in neutral rotation (NR), 45° of external rotation (ER), and 45° of internal rotation (IR). The coracoid base lengthened with IR in all positions and shortened in ER in the lateral decubitus position but not in the BC position. Abduction significantly lengthened the coracoid base, which was shortest in the BC position with ER (24 ± 4 mm) and longest in the lateral decubitus 2 position with IR (33 ± 5 mm). The coracoid base, where sutures are placed during plication of the interval, was observed to lengthen and, therefore, loosen with IR and abduction. To prevent postoperative ER restriction, plication should be made in ER or neutral rotation when operating in the BC position and the degree of abduction should be decreased and the shoulder held in ER when operating in the lateral decubitus position.