Morphology of the humeral insertion of the supraspinatus and infraspinatus tendons: Application to rotator cuff repair

Abstract

In shoulder surgery, a precise understanding of anatomical relationships is required for accurate reconstruction. Reports in recent literature have challenged the traditional definitions of the humeral footprints of the supraspinatus and infraspinatus tendons. This study aims to precisely delineate these footprints. The rotator cuffs of 54 shoulders from 27 Australian Caucasoid donor cadavers were examined. The tendinous portions were dissected down to their region/footprint of attachment upon the humerus. Measurements of those footprints, upon the greater and lesser tuberosities, were made. Those measurements were statistically analyzed for any association with age, sex, height, or side. Twenty-seven cadavers had an average age at death of 74.9 (± 12.8), 56% were male, average height was 168 (± 8.6) cm. Due to premorbid fracture, or degeneration, 11 shoulders were excluded. The footprint of the supraspinatus was triangular, with a medial, anteroposterior length of 20.4 ± 4.2 mm. Its lateral anteroposterior length was 6.3 ± 1.6 mm and its maximal mediolateral width was 6.6 ± 2.7 mm. Its calculated area was 122.0 ± 66.6 mm(2). The footprint of the infraspinatus was trapezoidal, with a medial anteroposterior length 22.6 ± 3.0 mm. Its lateral anteroposterior length was 25.4 ± 3.3mm and its maximal mediolateral width was 12.0 ± 2.7 mm. Its calculated area was 294.9 ± 74.1 mm(2). There was no statistical correlation between size of the footprint and age, sex, side, or height. The humeral footprints of the supraspinatus and infraspinatus tendons upon the greater tuberosity were distinct. The lateral border of the infraspinatus' humeral attachment extended much farther anteriorly upon the highest facet of the greater tuberosity than in traditional descriptions.

Inter-and Intra-Examiner Reliability of Supraspinatus Muscle Tendon Palpation: A Cross-Sectional Study by Ultrasonography

“…Sociodemographic variables such as gender, dominant arm, age, and BMI were evaluated. A statistically significant difference for these variables was not found regarding SMT location, which matches previous studies related to palpation and location of anatomic structures [33,34]. However, weight showed statistically significant differences, even if BMI did not (p =.02).…”

Retears of the Rotator Cuff: An Ultrasonographic Assessment During the First Postoperative Year

“…Footprint measurement after preparation for RC reinsertion in the greater tuberosity is a more reliable value that is unaffected by the age, sex, height, size, or position of the patient. 26 Measurements exceeding footprint exposure by 2.5 cm indicate that the supraspinatus is fully involved as well as at least 50% of the infraspinatus. On the other hand, despite moderate reliability in terms of interobserver assessments of retraction and fat degeneration on MRI (Patte and Goutallier), 24 there is a consensus regarding a poorer prognosis in patients with Patte grade 2 or 3 and Goutallier grade 3 or 4 during midterm clinical and structural follow-up.…”

Location of Rotator Cuff Tear Initiation: A Magnetic Resonance Imaging Study of 191 Shoulders

“…Recent reports questioned the conventional definitions of the humeral footprints of the SSP and ISP tendons. 10,11 According to the traditional theory, the location 13 to 17 mm posterior to the biceps tendon is recognized as the entire part or portion of the SSP tendon. 4,13 However, a recent anatomic study by Mochizuki et al 11 reported findings in contrast with what previous studies had demonstrated.…”