Histologic and biomechanical characteristics of the supraspinatus tendon: Reference to rotator cuff tearing

Nakajima, Takahiro; Rokuuma, Nobuyuki; Hamada, Keisuke; Tomatsu, Taisuke; Fukuda, Hiroaki

doi:10.1016/s1058-2746(09)80114-6

Cited by 235 publications

(141 citation statements)

References 18 publications

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“…The rotator cuff possesses contractile force generating tissue consisting of varying pennation and multiple force directions. [23][24][25][26][27] Models that lump the subregions as one muscle unit lack fidelity in representing a muscle's force and moment generating ability.…”

Section: Discussionmentioning

confidence: 99%

Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles

Langenderfer

Patthanacharoenphon

Carpenter

et al. 2006

Journal Orthopaedic Research

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A rotator cuff tear causes morphologic changes in rotator cuff muscles and tendons and reduced shoulder strength. The mechanisms by which these changes affect joint strength are not understood. This study's purpose was to empirically determine rotation moment arms for subregions of supraspinatus, infraspinatus, and for teres minor, and to test the hypothesis that subregions of the cuff tendons increase their effective moment arms through connections to other subregions. Tendon excursions were measured for full ranges of rotation on 10 independent glenohumeral specimens with the humerus abducted in the scapular plane at 10 and 608. Supraspinatus and infraspinatus tendons were divided into equal width subregions. Two conditions were tested: tendon divided to the musculotendinous junction, and tendon divided to the insertion on the humerus. Moment arms were determined from tendon excursion via the principle of virtual work. Moment arms for the infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly greater when the tendon was only divided to the musculotendinous junction versus division to the humeral head. Moment arms across subregions of infraspinatus (p < 0.001) and supraspinatus (p < 0.001) were significantly different. A difference in teres minor moment arm was not found for the two cuff tendon conditions. Moment arm differences between muscle subregions and for tendon division conditions have clinical implications. Interaction between cuff regions could explain why some subjects retain strength after a small cuff tear. This finding helps explain why a partial cuff repair may be beneficial when a complete repair is not possible. Data presented here can help differentiate between cuff tear cases that would benefit from cuff repair and cases for which cuff repair might not be as favorable. ß

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Section: Discussionmentioning

confidence: 99%

Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles

Langenderfer

Patthanacharoenphon

Carpenter

et al. 2006

Journal Orthopaedic Research

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“…In our study, however, the amplitude of in vivo intratendinous strain was much higher than that seen in previous studies. 9,10 While the highest average strain reported within the tendon was 15% in the superior region of the insertion site in the cadaver study, 16 we found a peak strain of 17.03 AE 1.69% in the superficial region during isometric motion. We believe this difference is attributable to a discrepancy between in vivo and in vitro conditions.…”

Section: In Vivo Strain Of Supraspinatus Tendonmentioning

confidence: 48%

“…3,9,10,16 However, previous studies were performed on cadavers. We employed 2D STE to produce ''fingerprints'' for a given region, a feasible and reproducible method to assess the in vivo characteristics of the tendon.…”

Section: In Vivo Strain Of Supraspinatus Tendonmentioning

confidence: 99%

In vivo strain analysis of the intact supraspinatus tendon by ultrasound speckles tracking imaging

Kim

Bigliani

et al. 2011

Journal Orthopaedic Research

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Limited data exist regarding why delaminated tears occur within the rotator cuff tendon, and no general agreement exists on how to handle this complicated tear. To analyze in vivo intratendinous strain of the supraspinatus tendon, the superficial, middle, and deep regions were marked with speckles using 2D speckle tracking echocardiography (2D STE) of 15 shoulders. The displacement and the strain of each speckle during isotonic and isometric shoulder motion were evaluated. Significantly different displacement and strains in the tendon were found between isometric and isotonic shoulder motions. In isometric motion, the average longitudinal displacement of the speckle at the superficial region (1.66 mm) was larger than at the deep region (0.61 mm), and the average peak strain at the superficial region (17.03%) was also higher than that at the deep region (3.42%). Conversely, in isotonic motion, the average longitudinal displacement of the speckle at the superficial region (0.70 mm) was less than that at the deep region (1.61 mm), and the average peak strain at the superficial region (4.73%) was also lower than that at the deep region (15.69%). A different strain was found between the superficial and deep regions within the intact live supraspinatus tendon. The strain and displacement patterns vary according to isometric versus isotonic shoulder motions. On the basis of our observations, we suggest that the delaminated tear of the rotator cuff tendon must be repaired separately layer by layer to resist the inhomogeneous strain after the repair. Keywords: rotator cuff tendon; in vivo; strain; 2D speckle tracking echocardiography; isotonic; isometric Rotator cuff tendon tears represent one of the most common causes of shoulder pain and disability. The tear configuration is variable and includes partialthickness tears, which originate on the articular side, the bursal side, or within the tendon substance, and full-thickness tears. Previous studies suggested that intratendinous delaminated tears occur often, accounting for almost half of all partial-thickness tears. 1,2 Furthermore, many full thickness tears have a delaminated component. However, limited data exist regarding why delaminated tears occur, and no general agreement exists on how to handle this complicated tear.Several studies demonstrated that the biomechanical behavior of the nonlinear response to loading the tendon is related to the tear pattern. 3-7 Different material properties and strain patterns exist between the articular and bursal sides of the supraspinatus tendon. 2,3,[8][9][10][11] showed that the rotator cuff tendon has different histological features in the joint and bursal layers, and the joint side has lower ultimate strain than the bursal side does. Reilly et al. 10 noted, in a cadaver study, a significant difference in strain between the joint and bursal sides of the supraspinatus tendon during glenohumeral abduction. They suggested that the difference may contribute to the propagation of intratendinous delaminated defects. 10 Be...

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“…The majority of partial-thickness RCTs involve the articular side [7,15]. This might be secondary to hypovascularity and reduced biomechanical strength [15,19]. Nakajima et al [19] found the bursal portion of the rotator cuff was able to undergo greater deformation and had increased tensile strength when compared to the articular portion.…”

Section: Discussionmentioning

confidence: 99%

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

Spencer

2010

Clinical Orthopaedics &Amp; Related Research

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Background Treatment of partial-thickness articular surface rotator cuff tears varies from simple débridement with or without an acromioplasty to various repair techniques. These repair techniques have included in situ transtendinous methods, as well as completion of the tear and repairing the full-thickness defect. The transtendinous techniques can be associated with stiffness and completing the tear takes down normal intact tissue. Therefore, a technique was developed that repairs the articular-side partial-thickness rotator cuff tears with an all-inside approach that does not violate the intact bursal tissue and does not complete the tear. Questions/purposes To compare the preoperative and postoperative Penn shoulder scores (PSS) associated with an in situ all-inside repair technique and the effects of such a repair on postoperative stiffness. Methods Twenty patients with partial-thickness articular rotator cuff tears greater than 50% of the width of the tendon repaired with an all-inside repair technique were retrospectively reviewed. Two of the patients were high school athletes and the rest self-described as recreational athletes. The minimum followup was 16 months (average, 29 months; range, 16-41 months). A validated outcome measure (PSS) was used to assess clinical outcome, and postoperative ROM was measured. Results The average PSS score improved from 74 (range, 56-84) to 92 (range, 86-99).

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Histologic and biomechanical characteristics of the supraspinatus tendon: Reference to rotator cuff tearing

Cited by 235 publications

References 18 publications

Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles

Variation in external rotation moment arms among subregions of supraspinatus, infraspinatus, and teres minor muscles

In vivo strain analysis of the intact supraspinatus tendon by ultrasound speckles tracking imaging

Partial-thickness Articular Surface Rotator Cuff Tears: An All-inside Repair Technique

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