A rotator cuff rupture produces permanent osteoporosis in the affected extremity, but not in those with whom shoulder function has returned to normal

Abstract

Areal bone mineral density (BMD) and clinical status of 34 men treated surgically 9 years earlier for a rotator cuff rupture of the dominant side shoulder were determined. The BMD was measured at the lumbar spine (L2-L4) and the proximal humerus, humeral shaft, radial shaft, ulnar shaft, distal forearm, and hand of both extremities using a dual-energy X-ray absorptiometric (DXA) scanner. Thirty-four age-, height-, weight-, and profession-matched normal men (controls) were also measured. The patients' mean side-to-side BMD difference (dominant minus nondominant/nondominant x 100%) was significantly lower in the proximal humerus (patients -3.5% vs. controls +2.4%, p = 0.0002), humeral shaft (-2.6% vs. +1.6%, p = 0.0005), radial shaft (-0.4% vs. +1.9%, p = 0.0311), distal forearm (-0.2% vs. +2.4%, p = 0.0158), and hand (+2.3% vs. +4.0%, p = 0.0047). In the ulnar shaft, this difference was almost the same in the patients (-0.2%) and controls (+0.2%) (NS). Also, the lumbar spine BMD did not differ significantly between these groups (mean +/- SD = 1.098 +/- 0.148 g/cm2 in patients vs. 1.066 +/- 0.156 g/cm2 in controls). In patients, the relative BMDs of the injured extremity did not significantly associate with the size of the rupture; time delay between the injury and the surgery; type of surgery and postoperative treatment; postoperative immobilization time; follow-up time; patient's age, muscle strength or pain assessment; and subjective assessment of shoulder function. However, they strongly associated with the objective assessment of the shoulder function: the better the observed function of the shoulder, the less bone loss caused by the injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Early anchor displacement after arthroscopic rotator cuff repair

“…the insertion zone of the anchor had no significant effect on implant disengagement in our series. This difference can be explained by the fact that Tingart used cadavers without shoulder pathology, while in patients with rotator cuff tear permanent osteoporosis has been found [24]. As in the publication by Benson et al [11], so in our study, anchor pullout was always observed from the greater tuberosity.…”

“…the lower the bone mineral density is, the easier the anchor will cut out of the humerus [17]. The prevalence of osteoporosis is higher in women and increases with age, and furthermore there is evidence that rotator cuff tear can aggravate proximal humeral osteoporosis [24]. It can therefore be assumed that anchor displacement would occur more frequently in elderly women.…”

Análise comparativa da sutura artroscópica de lesões grandes e extensas do manguito rotador com relação ao grau de osteopenia

“…Foi verificado que os pacientes que conseguem melhorar a função do MS com o tratamento conservador apresentam menor perda óssea localizada. 19 Galatz et al 20 demonstraram uma deterioração das propriedades de cicatrização tecidual no grupo de pacientes nos quais o reparo da lesão tendinosa foi tardio que coincide com a perda massa óssea no tubérculo maior. Esses resultados, também verificados por Charousset et al, 11 indicam que a perda de massa óssea no tubérculo maior pode ser um fator importante de má cicatrização.…”

“…[13][14][15][16][17] Alguns dados a respeito da perda de massa óssea no tubér-culo maior induzida pela lesão do MR estão publicados na literatura. [18][19][20] Esses dados e alguns estudos mecânicos sugerem um possível efeito deletério da osteopenia na cicatrização pós-operatória do MR. 11,21,22 Não encontramos dados de aná-lise da relação entre a perda óssea inerente ao envelhecimento com o resultado da sutura artroscópica do MR.…”

Surgical Treatment Options in Patients With Impaired Bone Quality

“…The bone quality of the proximal humerus (greater tuberosity specifically) has been believed to be a relevant factor in determining the strength of fixation of suture anchors used for rotator cuff repair [8,39,109] along with tendon quality and tendon-grasping technique [6,39,65]. Higher rotator cuff rerupture and failure rates have been clinically observed in osteoporotic bone [50] as determined by DXA.…”