Sunday, June 14, 2015

Rotator cuff tears - which supraspinatus tears are most likely to propagate?

Effect of tear location on propagation of isolated supraspinatus tendon tears during increasing levels of cyclic loading.

These authors tested 23 fresh-frozen human cadaveric shoulders under increasing levels of cyclic loading. 1 cm tears were created in the anterior third (Group A, n=10) or the middle third (Group M, n=13) of the supraspinatus tendon. 

No significant differences were found between the anterior-third tear group (Group A) and the middle-third tear group (Group M) in maximum load (p=0.09) or tear area (p=0.6). However, Group A first reached a 100% increase in tear size at a significantly lower load than Group M (p=0.03). 

Strong negative correlations were detected between age and maximum load in Group A (τ=-0.82) and Group M (r=-0.63).

Comment: As pointed out by Clark and Harryman in 1992, the anterior part of the supraspinatus tendon is the strongest part of that tendon, just as the upper part of the subscapularis is the strongest part of that tendon. 

This cadaver model suggests that an incision in the anterior supraspinatus may be more likely to propagate than a tear of similar length in the middle of the tendon.

The effect of age on tendon strength was again noted and may help understand why older individuals are more likely to have cuff tears and why repairs of these tears are less likely to achieve durable integrity.


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