Bone density of the greater tuberosity is decreased in rotator cuff disease with and without full-thickness tears

Waldorff, Erik I.; Lindner, James R.; Kijek, Theresa Guckian; Downie, Brian; Hughes, R.; Carpenter, James E.; Miller, Bruce S.

doi:10.1016/j.jse.2010.12.009

Cited by 40 publications

(25 citation statements)

References 15 publications

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“…13 Prolonged detachment of rotator cuff tendons has been shown to lead to increased muscle stiffness 14 and repair tension, 9 which has detrimental effects on post-repair healing outcomes. Additionally, chronic rotator cuff injury has been associated with reduced bone quality at the greater tuberosity, 15 with increased bone loss associated with impaired post-repair healing outcomes. 10 Clinically, efforts have been made to improve surgical techniques in order to improve tendon healing.…”

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confidence: 99%

The effects of chronic unloading and gap formation on tendon-to-bone healing in a rat model of massive rotator cuff tears

Killian

Cavinatto

Shah³

et al. 2013

J. Orthop. Res.

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The objective of this study was to understand the effect of pre-repair rotator cuff chronicity on post-repair healing outcomes using a chronic and acute multi-tendon rat rotator cuff injury model. Full-thickness dual tendon injuries (supra- and infraspinatus) were created unilaterally in adult male Sprague Dawley rats, and left chronically detached for 8 or 16 weeks. After chronic detachment, tears were repaired and acute dual tendon injuries were created and immediately repaired on contralateral shoulders. Tissue level outcomes for bone, tendon, and muscle were assessed 4 or 8 weeks after repair using histology, microcomputed tomography, biomechanical testing, and biochemical assays. Substantial gap formation was seen in 35% of acute repairs and 44% of chronic repairs. Gap formation negatively correlated with mechanical and structural outcomes for both healing time points regardless of injury duration. Bone and histomorphometry, as well as biomechanics, were similar between acute and chronic injury and repair regardless of chronicity and duration of healing. This study was the first to implement a multi-tendon rotator cuff injury with surgical repair following both chronic and acute injuries. Massive tear in a rodent model resulted in gap formation regardless of injury duration which had detrimental effects on repair outcomes.

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mentioning

confidence: 99%

The effects of chronic unloading and gap formation on tendon-to-bone healing in a rat model of massive rotator cuff tears

Killian

Cavinatto

Shah³

et al. 2013

J. Orthop. Res.

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“…This in turn results in both nutritional and mechanical factors that cause disuse osteoporosis of the humeral head. Some clinical studies have also shown osteopenic changes in the greater tuberosity in patients with chronic rotator cuff tears, and this finding was attributed to the loss of physical stimuli at the tendon insertion point, in accordance with Wolff’s law [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 81%

Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

et al. 2015

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IntroductionAn increased bone mineral density (BMD) in the proximity to tendon insertion can improve rotator cuff repair and healing. However, how a decrease of BMD in the humeral head affects the biomechanical properties of the rotator cuff tendon is still unclear. Previous studies have demonstrated ovariectomy in animals to lead to osteoporosis and decreased BMD, and Teriparatide (PTH) administration to improve BMD and strength of bone. This study aimed to explore the correlation between humeral head BMD and infraspinatus (ISP) tendon insertion strength, and if an increase in bone quantity of the humeral head can improve the strength of the rotator cuff.Materials and MethodsEighteen New England white rabbits were divided into the 3 groups: Control, Ovariectomy-Saline (OVX-Saline), and Ovariectomy-PTH (OVX-PTH). The OVX-Saline group and the OVX-PTH were administered daily saline and Teriparatide injections for 8 weeks starting at 17 weeks of OVX. BMD of the humeral head was measured, the ISP tendon failure load was tested and the failure stress was calculated. One specimen from each group was used for histological analysis. Linear regression analysis was used to derive equations for the BMD and failure stress.ResultsSignificant differences were observed in the measured humeral head BMD of the Control and OVX-PTH groups compared to the OVX-Saline group (P = 0.0004 and P = 0.0024, respectively). No significant difference was found in failure stress among the three groups, but an expected trend with the control group and OVX-PTH group presenting higher failure strength compared to the OVX-Saline group. BMD at the humeral head showed a positive linear correlation with stress (r2 = 0.54). Histology results showed the superiority in OVX-PTH group ISP enthesis compared to the OVX-Saline group.ConclusionBone loss of the humeral head leads to decreased tendon/bone insertion strength of the infraspinatus tendon enthesis. Teriparatide administration can increase bone density of the humeral head and may improve the mechanical properties of the infraspinatus tendon enthesis.

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“…Some data regarding bone mass losses from the greater tubercle induced by rotator cuff injuries have been published in the literature. 18 , 19 , 20 These data, along with some mechanical studies, suggest that osteopenia may have a deleterious effect on the postoperative healing of the rotator cuff. 11 , 21 , 22 We were unable to find any data analyses on the relationship between the bone loss inherent to aging and the results from arthroscopic suturing of the rotator cuff.…”

Section: Introductionmentioning

confidence: 89%

Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia

Almeida¹,

Atti

Agostini³

et al. 2015

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo analyze the results from arthroscopic suturing of large and extensive rotator cuff injuries, according to the patient's degree of osteopenia.Method138 patients who underwent arthroscopic suturing of large and extensive rotator cuff injuries between 2003 and 2011 were analyzed. Those operated from October 2008 onwards formed a prospective cohort, while the remainder formed a retrospective cohort. Also from October 2008 onwards, bone densitometry evaluation was requested at the time of the surgical treatment. For the patients operated before this date, densitometry examinations performed up to two years before or after the surgical treatment were investigated. The patients were divided into three groups. Those with osteoporosis formed group 1 (n = 16); those with osteopenia, group 2 (n = 33); and normal individuals, group 3 (n = 55).ResultsIn analyzing the University of California at Los Angeles (UCLA) scores of group 3 and comparing them with group 2, no statistically significant difference was seen (p = 0.070). Analysis on group 3 in comparison with group 1 showed a statistically significant difference (p = 0.027).ConclusionThe results from arthroscopic suturing of large and extensive rotator cuff injuries seem to be influenced by the patient's bone mineral density, as assessed using bone densitometry.

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Bone density of the greater tuberosity is decreased in rotator cuff disease with and without full-thickness tears

Cited by 40 publications

References 15 publications

The effects of chronic unloading and gap formation on tendon-to-bone healing in a rat model of massive rotator cuff tears

The effects of chronic unloading and gap formation on tendon-to-bone healing in a rat model of massive rotator cuff tears

Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

Comparative analysis on arthroscopic sutures of large and extensive rotator cuff injuries in relation to the degree of osteopenia

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