Research Papers

Effect of Supraspinatus Tendon Repair Technique on the Infraspinatus Tendon

[+] Author and Article Information
Nelly Andarawis-Puri

 Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1188, New York, NY 10029nelly.andarawis@mountsinai.org

Andrew F. Kuntz

Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104andrew.kuntz@uphs.upenn.edu

Matthew L. Ramsey

Rothman Institute, Thomas Jefferson University, Philadelphia, PA 19107mlramsey2@verizon.net

Louis J. Soslowsky1

McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104–6081soslowsk@upenn.edu


Corresponding author.

J Biomech Eng 133(3), 031008 (Feb 07, 2011) (6 pages) doi:10.1115/1.4003326 History: Received August 29, 2010; Revised December 15, 2010; Posted December 22, 2010; Published February 07, 2011; Online February 07, 2011

Supraspinatus tendon tears are common and often propagate into larger tears that include the infraspinatus tendon, resulting in loss of function and increased pain. Previously, we showed that the supraspinatus and infraspinatus tendons mechanically interact through a range of rotation angles, potentially shielding the torn supraspinatus tendon from further injury while subjecting the infraspinatus tendon to increased risk of injury. Surgical repair of torn supraspinatus tendons is common, yet the effect of the repair on the infraspinatus tendon is unknown. Since we have established a relationship between strain in the supraspinatus and infraspinatus tendons the success of a supraspinatus tendon repair depends on its effect on the loading environment in the infraspinatus tendon. More specifically, the effect of transosseous supraspinatus tendon repair in comparison to one that utilizes suture anchors, as is commonly done with arthroscopic repairs, on this interaction through these joint positions will be evaluated. We hypothesize that at all joint positions evaluated, both repairs will restore the interaction between the two tendons. For both repairs, (1) increasing supraspinatus tendon load will increase infraspinatus tendon strain and (2) altering the rotation angle from internal to external will increase strain in the infraspinatus tendon. Strains were measured in the infraspinatus tendon insertion through a range of joint rotation angles and supraspinatus tendon loads, for the intact, transosseous, and suture anchor repaired supraspinatus tendons. Images corresponding to specific supraspinatus tendon loads were isolated for the infraspinatus tendon insertion for analysis. The effect of supraspinatus tendon repair on infraspinatus tendon strain differed with joint position. Altering the joint rotation did not change strain in the infraspinatus tendon for any supraspinatus tendon condition. Finally, increasing supraspinatus tendon load resulted in an increase in average maximum and decrease in average minimum principal strain in the infraspinatus tendon. There is a significant difference in infraspinatus tendon strain between the intact and arthroscopically (but not transosseous) repaired supraspinatus tendons that increases with greater loads. Results suggest that at low loads neither supraspinatus tendon repair technique subjects the infraspinatus tendon to potentially detrimental loads; however, at high loads, transosseous repairs may be more advantageous over arthroscopic repairs for the health of the infraspinatus tendon. Results emphasize the importance of limiting loading of the repaired supraspinatus tendon and that at low loads, both repair techniques restore the interaction to the intact supraspinatus tendon case.

Copyright © 2011 by American Society of Mechanical Engineers
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Grahic Jump Location
Figure 1

Contrary to H1, at 0 deg abduction and 30 deg internal rotation, there was a significant difference between infraspinatus tendon strain associated with the intact than arthroscopically repaired supraspinatus tendons. At 30 deg internal rotation, average maximum principal strain in the infraspinatus tendon was lower for the arthrosopic repaired supraspinatus tendon than the intact tendon case at (a) 60 N and (b) 90 N. At 0 deg abduction, average minimum principal strain in the infraspinatus tendon was less compressive for the arthroscopic repaired than the intact supraspinatus tendon at all loads (shown for (c) 60 N and (d) 90 N).

Grahic Jump Location
Figure 2

At joint positions where a significant difference was found in infraspinatus tendon strain for repaired than intact supraspinatus tendon cases, the difference increased with greater supraspinatus tendon load. At 30 deg internal rotation (a), the difference in average maximum principal strain in the infraspinatus tendon strain between arthroscopic repaired and intact supraspinatus tendon cases was significantly higher at 90 N than at 30 N. Similarly, at 0 deg abduction, the difference in average minimum principal strain in the infraspinatus tendon between intact and (b) arthroscopic or (c) transosseous repaired supraspinatus tendon was significantly greater at 90 N than at 30 N.

Grahic Jump Location
Figure 3

For the transosseous repaired supraspinatus tendon case, increasing supraspinatus tendon load resulted in a significant increase in average maximum principal strain in the infraspinatus tendon at (a) 0 deg abduction, (b) 30 deg external rotation, and (c) 30 deg internal rotation

Grahic Jump Location
Figure 4

For the arthroscopic repaired supraspinatus tendon case, increase in supraspinatus tendon load resulted in significantly less compressive average minimum principal strain in the infraspinatus tendon for (a) 0 deg abduction, (b) 30 deg external rotation, and (c) 30 deg internal rotation




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