In-Ho JEON, So Hyun PARK, Sung Jung b KİM, Hyun-Joo LEE, Erica KHOLİNNE

The relationship between age, rotator cuff integrity, and osseous microarchitecture of greater tuberosity: Where should we put anchor?

Objective: The aim of this study was to compare the microarchitecture of the greater tuberosity with orwithout rotator cuff tear and to obtain optimum location for anchor screw insertion for rotator cuff repair.Methods: Twenty-Şve humeral heads were harvested from 13 male cadavers of mean age 58.4 years,including 6 humeri with rotator cuff tear and 19 intact humeri. Six regions of interest (proximal, intermediate,and distal zones of the superŞcial and deep regions) were divided into the anterior (G1), middle (G2), andposterior (G3) areas of the greater tuberosity. Trabecular bone volume and cortical thickness were evaluated.Results: Total trabecular bone volume was greater in subjects<50 years old than in subjects >50 yearsold but did not differ signiŞcantly in subjects with and without rotator cuff tear. Cortical thickness inboth intact and torn rotator cuff groups was signiŞcantly greater in the proximal and intermediate zonesthan in the distal zone. Cortical thickness was related to anatomic location rather than age or cuff tear.Conclusion: The optimal location for anchor screw insertion during rotator cuff repair is either theproximal or intermediate region of the greater tuberosity. Age has more influence in terms of trabecularbone volume loss than rotator cuff integrity.© 2017 Publishing services by Elsevier B.V. on behalf of Turkish Association of Orthopaedics andTraumatology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

___

Barber FA, Feder SM, Burkhart SS, Ahrens J. The relationship of suture anchor failure and bone density to proximal humerus location: a cadaveric study. Arthroscopy. 1997;13:340e345. https://doi.org/10.1016/S0749-8063(97)90031-1.

Park JY, Kim MH. Changes in bone mineral density of the proximal humerus in Koreans: suture anchor in rotator cuff repair. Orthopedics. 2004;27:857e861. https://doi.org/10.3928/0147-7447-20040801-22.

Liew AS, Johnson JA, Patterson SD, King GJ, Chess DG. Effect of screw placement onŞxation in the humeral head. J Shoulder Elbow Surg. 2000;9:423e426. https://doi.org/10.1067/mse.2000.107089.

Tingart MJ, Apreleva M, Zurakowski D, Warner JJ. Pullout strength of suture anchors used in rotator cuff repair. J Bone Joint Surg Am. 2003;85-A:2190e2198. https://doi.org/10.2106/00004623-200311000-00021.

Mitton D, Cendre E, Roux JP, et al. Mechanical properties of ewe vertebral cancellous bone compared with histomorphometry and high-resolution computed tomography parameters. Bone. 1998;22:651e658. https://doi.org/ 10.1016/S8756-3282(98)00036-2.

Meyer DC, Fucentese SF, Koller B, Gerber C. Association of osteopenia of the humeral head with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2004;13:333e337. https://doi.org/10.1016/s1058274603003306.

Tingart MJ, Lehtinen J, Zurakowski D, Warner JJ, Apreleva M. Proximal humeral fractures: regional differences in bone mineral density of the humeral head affect theŞxation strength of cancellous screws. J Shoulder Elbow Surg. 2006;15:620e624. https://doi.org/10.1016/j.jse.2005.09.007.

Tingart MJ, Apreleva M, Lehtinen J, Zurakowski D, Warner JJ. Anchor design and bone mineral density affect the pull-out strength of suture anchors in rotator cuff repair: which anchors are best to use in patients with low bone quality? Am J Sports Med. 2004;32:1466e1473. https://doi.org/10.1177/0363546503262644.

Rossouw DJ, McElroy BJ, Amis AA, Emery RJ. A biomechanical evaluation of suture anchors in repair of the rotator cuff. J Bone Joint Surg Br. 1997;79: 458e461. https://doi.org/10.1302/0301-620x.79b3.6983.

Pietschmann MF, Holzer A, Rosl C, et al. What humeri are suitable for comparative testing of suture anchors? An ultrastructural bone analysis and biomechanical study of ovine, bovine and human humeri and four different anchor types. J Biomech. 2010;43:1125e1130. https://doi.org/10.1016/j.jbiomech.2009.12.021.

Amis AA. The strength of artiŞcial ligament anchorages: a comparative experimental study. J Bone Joint Surg Br. 1988;70-B:397e403.

Hecker AT, Shea M, Hayhurst JO, Myers ER, Meeks LW, Hayes WC. Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs. Am J Sports Med. 1993;21:874e879. https://doi.org/10.1177/036354659302100621.

Reilly DT, Burstein AH. The mechanical properties of cortical bone. J Bone Joint Surg Am. 1974;56-A:1001e1022. https://doi.org/10.2106/00004623-197456050-00012.

Van Auderkercke R, Martens M. Mechanical properties of can- cellous bone. In: Hastings G, Ducheyne P, eds. Natural and Living Biomaterials. Boca Raton: CRC Press; 1984:89e98.