Remodeling of the repaired supraspinatus tendon

 The Fate of Sutures Post Rotator Cuff Repair

These authors used ultrasound to sequentially characterize the supraspinatus insertion after arthroscopic repair in 21 patients, 14 (67%) with full thickness tears and 7 (33%) with partial thickness tears.  During each assessment the total supraspinatus tendon thickness, the thickness of tendon tissues

below and above the sutures, the anatomical footprint and the modulus of elasticity were measured. 

Longitudinal and Schematic View of the Left Supraspinatus Tendon:

(a) Anatomical footprint, 

(b) Tendon thickness at the footprint-articular junction, 

(c) Bursal to suture tendon thickness at footprint-articular junction (FAJ), 

(d) Suture to articular surface tendon thickness at FAJ, 

(e) Tendon thickness at medial tip of the suture, 

(f) Bursal to suture tendon thickness at medial tip of the suture, 

(g) Suture to articular surface tendon thickness at medial tip of the suture 

(h) Location where tendon stiffness and modulus of elasticity were measured with shear wave elastography in which a focused ultrasonic pulse provides qualitative and quantitative information on the elasticity and stiffness of a tissue.

Within the first 12 weeks after repair, the sutures migrated from the surface through to the middle of the tendon at the footprint-articular junction (i.e., ratio of tendon tissue thickness below the suture to the total tendon thickness was 0.5). 

The mean anatomical footprint increased from 8.4 mm to 9.1 mm between 8 days and 6 weeks.

Bursal thickness decreased during the 24-week period from 1.5 mm to 0.7 mm.

Tendon modulus of elasticity increased from 154 kPa to 205 kPa between 8 days and 24 weeks.

Comment: This is an interesting study that demonstrates the change in relative suture position, repair site anatomy, and structural properties of the repaired tendon. As suggested by the previous post, it would have been of interest to see how the ultrasonographic appearance correlated with the MRI appearance during this period of time after surgical repair.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The total shoulder arthroplasty (see this link).

The ream and run technique is shown in this link.

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

60 year old athlete with severe shoulder arthritis - glenoid remodeling after a ream and run.

A 60 year old rock climber and cross country skier had pain and stiffness in the right shoulder and these x-rays showing complete loss of radiographic joint space and posterior decentering of the humeral head in the arthritic glenoid.

He elected to have a ream and run procedure to avoid the risks and limitations associated with a plastic glenoid component. This was done without preop CT or plexus block.

His x-rays at 3 months show some early remodeling of the reamed glenoid.

Three years after his procedure, he had fully returned to his activities and had the x-rays below, showing complete remodeling of his glenoid articular surface. 

The ream and run technique is shown in this link.

How you can support research in shoulder surgery Click on this link.

Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).

Ream and run - remodeling at one year.

 A 62 year old active man presented with severe pain a year ago, unable to perform any of the functions of the Simple Shoulder Test and the x-rays below

One year after surgery he could perform 10 of the 12 SST functions and had the x-rays shown below showing glenoid remodeling

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Narcotics may interfere with bone healing

Postoperative Opioid Administration Inhibits Bone Healing in an Animal Model

The authors observe that opiod medications are the mainstay of orthopaedic pain control. They used a rat fracture model to evaluate the effects of opioid administration on bone union in an operatively stabilized fracture. After a 0.4-mm femoral osteotomy gap was created, rats were randomized to control versus morphine-treated study groups.


There was a statistically significant (p = 0.048) reduction in callus strength in morphine-treated animals 8 weeks postoperatively compared with controls. Radiographic and histological analysis showed delayed callus maturation and lack of remodeling in the morphine group compared with control animals at 8 weeks.

The authors concluded that administration of an opioid pain medication leads to weaker callus and impedes callus maturation compared with controls.



Comment: In fracture cases as well as in shoulder arthroplasty, bone healing and remodeling are important. The authors have given us yet another reason to consider minimizing our use of narcotics.


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