Optimal Lateral Row Anchor Positioning in Posterior-Superior Transosseous Equivalent Rotator Cuff Repair: A Micro-Computed Tomography Study

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2016 Dec 1

PMID 27900336

Citations 7

Authors

Matthias A Zumstein

Sumit Raniga

Agatha Labrinidis

Kevin Eng

Gregory I Bain

Beat K Moor

Affiliations

Soon will be listed here.

Abstract

Background: The optimal placement of suture anchors in transosseous-equivalent (TOE) double-row rotator cuff repair remains controversial.

Purpose: A 3-dimensional (3D) high-resolution micro-computed tomography (micro-CT) histomorphometric analysis of cadaveric proximal humeral greater tuberosities (GTs) was performed to guide optimal positioning of lateral row anchors in posterior-superior (infraspinatus and supraspinatus) TOE rotator cuff repair.

Study Design: Descriptive laboratory study.

Methods: Thirteen fresh-frozen human cadaveric proximal humeri underwent micro-CT analysis. The histomorphometric parameters analyzed in the standardized volumes of interest included cortical thickness, bone volume, and trabecular properties.

Results: Analysis of the cortical thickness of the lateral rows demonstrated that the entire inferior-most lateral row, 15 to 21 mm from the summit of the GT, had the thickest cortical bone (mean, 0.79 mm; = .0001), with the anterior-most part of the GT, 15 to 21 mm below its summit, having the greatest cortical thickness of 1.02 mm ( = .008). There was a significantly greater bone volume (BV; posterior, 74.5 ± 27.4 mm; middle, 55.8 ± 24.9 mm; anterior, 56.9 ± 20.7 mm; = .001) and BV as a percentage of total tissue volume (BV/TV; posterior, 7.3% ± 2.7%, middle, 5.5% ± 2.4%; anterior, 5.6% ± 2.0%; = .001) in the posterior third of the GT than in intermediate or anterior thirds. In terms of both BV and BV/TV, the juxta-articular medial row had the greatest value (BV, 87.3 ± 25.1 mm; BV/TV, 8.6% ± 2.5%; = .0001 for both) followed by the inferior-most lateral row 15 to 21 mm from the summit of the GT (BV, 62.0 ± 22.7 mm; BV/TV, 6.1% ± 2.2%; = .0001 for both). The juxta-articular medial row had the greatest value for both trabecular number (0.3 ± 0.06 mm; = .0001) and thickness (0.3 ± 0.08 μm; = .0001) with the lowest degree of trabecular separation (1.3 ± 0.4 μm; = .0001). The structure model index (SMI) has been shown to strongly correlate with bone strength, and this was greatest at the inferior-most lateral row 15 to 21 mm from the summit of the GT (2.9 ± 0.9; = .0001).

Conclusion: The inferior-most lateral row, 15 to 21 mm from the tip of the GT, has good bone stock, the greatest cortical thickness, and the best SMI for lateral row anchor placement. The anterior-most part of the GT 15 to 21 mm below its summit had the greatest cortical thickness of all zones. The posterior third of the GT also has good bone stock parameters, second only to the medial row. The best site for lateral row cortical anchor placement is 15 to 21 mm below the summit of the GT.

Clinical Relevance: Optimal lateral anchor positioning is 15 to 21 mm below the summit of the greater tuberosity in TOE.

Citing Articles

Current Understanding and New Advances in the Surgical Management of Reparable Rotator Cuff Tears: A Scoping Review.

Eckers F, Loske S, Ek E, Muller A J Clin Med. 2023; 12(5).

PMID: 36902499 PMC: 10003213. DOI: 10.3390/jcm12051713.

Arthroscopic Double-Row Repair of Posterosuperior Rotator Cuff Tears: Suture Bridge Technique Reinforced With Modified Mason-Allen and Simple Sutures.

Collotte P, Vieira T, Bois A Arthrosc Tech. 2023; 11(12):e2295-e2301.

PMID: 36632401 PMC: 9827121. DOI: 10.1016/j.eats.2022.08.039.

Use of a Dry Surgical Simulator Improves Orthopaedic Residents' Competency and Technical Skills for Arthroscopic Rotator Cuff Repair.

Chillemi C, Paolicelli D, Paglialunga C, Campopiano G, Guerrisi M, Proietti R Arthrosc Sports Med Rehabil. 2022; 4(3):e1039-e1049.

PMID: 35747668 PMC: 9210362. DOI: 10.1016/j.asmr.2022.02.010.

Optimizing Anchor Placement for Cone-Shaped Rotator Cuff Tears.

Yu V, Taliaferro J, Bonner K Arthrosc Tech. 2022; 11(3):e353-e357.

PMID: 35256975 PMC: 8897581. DOI: 10.1016/j.eats.2021.10.029.

Anchor Site Fracture Following Arthroscopic Rotator Cuff Repair - A Case Report and Review of the Literature.

Weller J, Birkner B, Schneider K, Durchholz H J Orthop Case Rep. 2021; 11(5):104-108.

PMID: 34557452 PMC: 8422010. DOI: 10.13107/jocr.2021.v11.i05.2228.

References

Craft D, Moseley J, Cawley P, Noble P . Fixation strength of rotator cuff repairs with suture anchors and the transosseous suture technique. J Shoulder Elbow Surg. 1996; 5(1):32-40. DOI: 10.1016/s1058-2746(96)80028-0. View

Tingart M, Apreleva M, Lehtinen J, Zurakowski D, Warner J . 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(6):1466-73. DOI: 10.1177/0363546503262644. View

Reed S, Glossop N . Full-thickness rotator cuff tears. A biomechanical comparison of suture versus bone anchor techniques. Am J Sports Med. 1996; 24(1):46-8. DOI: 10.1177/036354659602400108. View

Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F . Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997; (344):275-83. View

Perilli E, Parkinson I, Reynolds K . Micro-CT examination of human bone: from biopsies towards the entire organ. Ann Ist Super Sanita. 2012; 48(1):75-82. DOI: 10.4415/ANN_12_01_13. View

Ticker J, Warner J . Single-tendon tears of the rotator cuff. Evaluation and treatment of subscapularis tears and principles of treatment for supraspinatus tears. Orthop Clin North Am. 1997; 28(1):99-116. DOI: 10.1016/s0030-5898(05)70268-6. View

Gartsman G . All arthroscopic rotator cuff repairs. Orthop Clin North Am. 2002; 32(3):501-10, x. DOI: 10.1016/s0030-5898(05)70219-4. View

Guo X, Kim C . Mechanical consequence of trabecular bone loss and its treatment: a three-dimensional model simulation. Bone. 2002; 30(2):404-11. DOI: 10.1016/s8756-3282(01)00673-1. View

Meyer D, Fucentese S, Koller B, Gerber C . Association of osteopenia of the humeral head with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2004; 13(3):333-7. DOI: 10.1016/j.jse.2003.12.016. View

10.

Burkhart S . The deadman theory of suture anchors: observations along a south Texas fence line. Arthroscopy. 1995; 11(1):119-23. DOI: 10.1016/0749-8063(95)90100-0. View

11.

Barber F, Herbert M . Suture anchors--update 1999. Arthroscopy. 1999; 15(7):719-25. DOI: 10.1016/s0749-8063(99)70003-4. View

12.

Hecker A, Shea M, Hayhurst J, Myers E, Meeks L, Hayes W . Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs. Am J Sports Med. 1993; 21(6):874-9. DOI: 10.1177/036354659302100621. View

13.

Mittra E, Rubin C, Qin Y . Interrelationship of trabecular mechanical and microstructural properties in sheep trabecular bone. J Biomech. 2005; 38(6):1229-37. DOI: 10.1016/j.jbiomech.2004.06.007. View

14.

Meier S, Meier J . Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg. 2006; 15(6):691-6. DOI: 10.1016/j.jse.2006.03.004. View

15.

Perilli E, Baruffaldi F, Visentin M, Bordini B, Traina F, Cappello A . MicroCT examination of human bone specimens: effects of polymethylmethacrylate embedding on structural parameters. J Microsc. 2007; 225(Pt 2):192-200. DOI: 10.1111/j.1365-2818.2007.01731.x. View

16.

Boileau P, Brassart N, Watkinson D, Carles M, Hatzidakis A, Krishnan S . Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?. J Bone Joint Surg Am. 2005; 87(6):1229-40. DOI: 10.2106/JBJS.D.02035. View

17.

Perilli E, Briggs A, Kantor S, Codrington J, Wark J, Parkinson I . Failure strength of human vertebrae: prediction using bone mineral density measured by DXA and bone volume by micro-CT. Bone. 2012; 50(6):1416-25. DOI: 10.1016/j.bone.2012.03.002. View

18.

Davison K, Siminoski K, Adachi J, Hanley D, Goltzman D, Hodsman A . Bone strength: the whole is greater than the sum of its parts. Semin Arthritis Rheum. 2006; 36(1):22-31. DOI: 10.1016/j.semarthrit.2006.04.002. View

19.

Kirchhoff C, Braunstein V, Milz S, Sprecher C, Fischer F, Tami A . Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair. Am J Sports Med. 2010; 38(3):564-9. DOI: 10.1177/0363546509354989. View

20.

Hildebrand T, Ruegsegger P . Quantification of Bone Microarchitecture with the Structure Model Index. Comput Methods Biomech Biomed Engin. 1997; 1(1):15-23. DOI: 10.1080/01495739708936692. View