PMID- 20118499 OWN - NLM STAT- MEDLINE DCOM- 20100614 LR - 20220311 IS - 1552-3365 (Electronic) IS - 0363-5465 (Linking) VI - 38 IP - 3 DP - 2010 Mar TI - Assessment of bone quality within the tuberosities of the osteoporotic humeral head: relevance for anchor positioning in rotator cuff repair. PG - 564-9 LID - 10.1177/0363546509354989 [doi] AB - BACKGROUND: Tears of the rotator cuff are highly prevalent in patients older than 60 years, thereby presenting a population also suffering from osteopenia or osteoporosis. Suture fixation in the bone depends on the holding strength of the anchoring technique, whether a bone tunnel or suture anchor is selected. Because of osteopenic or osteoporotic bone changes, suture anchors in the older patient might pull out, resulting in failure of repair. HYPOTHESIS: The aim of our study was to analyze the bone quality within the tuberosities of the osteoporotic humeral head using high-resolution quantitative computed tomography (HR-pQCT). STUDY DESIGN: Descriptive laboratory study. METHODS: Thirty-six human cadaveric shoulders were analyzed using HR-pQCT. The mean bone volume to total volume (BV/TV) as well as trabecular bone mineral densities (trabBMDs) of the greater tuberosity (GT) and the lesser tuberosity (LT) were determined. Within the GT, 6 volumes of interest (VOIs) within the LT, and 2 VOIs and 1 control volume within the subchondral area beyond the articular surface were set. RESULTS: Comparing BV/TV of the medial and the lateral row, significantly higher values were found medially (P < .001). The highest BV/TV, 0.030% + or - 0.027%, was found in the posteromedial portion of the GT (P < .05). Regarding the analysis of the LT, no difference was found comparing the superior (BV/TV: 0.024% + or - 0.022%) and the inferior (BV/TV: 0.019% + or - 0.016%) portion. Analyzing trabBMD, equal proportions were found. An inverse correlation with a correlation coefficient of -0.68 was found regarding BV/TV of the posterior portion of the GT and age (P < .05). CONCLUSION: Significant regional differences of trabecular microarchitecture were found in our HR-pQCT study. The volume of highest bone quality resulted for the posteromedial aspect of the GT. Moreover, a significant correlation of bone quality within the GT and age was found, while the bone quality within the LT seems to be independent from it. CLINICAL RELEVANCE: The shape of the rotator cuff tear largely determines the bony site of tendon reattachment, although the surgeon has distinct options to modify anchor positioning. According to our results, placement of suture anchors in a medialized way at the border to the articular surface might guarantee a better structural bone stock. FAU - Kirchhoff, Chlodwig AU - Kirchhoff C AD - Department of Orthopedic Sports Surgery, Klinikum Rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, D-81675 Munich, Germany. Kirchhoff@lrz.tu-muenchen.de FAU - Braunstein, Volker AU - Braunstein V FAU - Milz, Stefan AU - Milz S FAU - Sprecher, Christoph M AU - Sprecher CM FAU - Fischer, Florian AU - Fischer F FAU - Tami, Andrea AU - Tami A FAU - Ahrens, Philipp AU - Ahrens P FAU - Imhoff, Andreas B AU - Imhoff AB FAU - Hinterwimmer, Stefan AU - Hinterwimmer S LA - eng PT - Journal Article DEP - 20100131 PL - United States TA - Am J Sports Med JT - The American journal of sports medicine JID - 7609541 SB - IM MH - Absorptiometry, Photon MH - Aged MH - Aged, 80 and over MH - *Bone Density MH - Cadaver MH - Female MH - Humans MH - Humerus/*diagnostic imaging/surgery MH - Male MH - Middle Aged MH - Osteoporosis/*diagnostic imaging/surgery MH - Range of Motion, Articular MH - *Rotator Cuff Injuries MH - *Suture Anchors EDAT- 2010/02/02 06:00 MHDA- 2010/06/15 06:00 CRDT- 2010/02/02 06:00 PHST- 2010/02/02 06:00 [entrez] PHST- 2010/02/02 06:00 [pubmed] PHST- 2010/06/15 06:00 [medline] AID - 0363546509354989 [pii] AID - 10.1177/0363546509354989 [doi] PST - ppublish SO - Am J Sports Med. 2010 Mar;38(3):564-9. doi: 10.1177/0363546509354989. Epub 2010 Jan 31.