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INTRODUCTION
Rotator cuff tears cause signicant pain and disability to the shoulder. The rotator cuff is composed
of four tendons that are important for coordinating
shoulder motion. The supraspinatus (SSP) tendon
contributes specically to abduction and stability of
the humeral head and is the most common site of
rotator cuff tears. Morphologically, the SSP tendon is
not a single fusiform tendon but consists of two subregions, anterior and posterior (Vahlensieck et al.,
C
V
703
Fig. 1. Sub-regional anatomy of supraspinatus anterior (ant) and posterior (post). (A) Intact. (B) Divided.
The anterior sub-region of the SSP tendon is thick and
tubular. The posterior sub-region is thin and strap-like.
[Color gure can be viewed in the online issue, which is
available at wileyonlinelibrary.com.]
Data Analysis
All data are represented as mean 6 standard deviation. Repeated measures were used for statistical
comparisons. The level of signicance was set at P <
0.05. Post hoc power calculations demonstrated that a
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Matsuhashi et al.
RESULTS
The overall anatomical dimensions of the anterior
and posterior sub-regions of the SSP tendon are
detailed in Figure 3. At all measurement sites (distal,
middle, and proximal), the posterior sub-region was
signicantly thinner than the anterior (P < 0.05). The
anterior sub-region had a signicantly greater crosssectional area than the posterior at the distal site (P <
0.05).
All parameters of the anterior sub-region (the modulus of elasticity, the ultimate failure load, and the
ultimate stress) were statistically signicantly greater
than those of the posterior sub-region (Fig. 4). The
Fig. 4. Results of mechanical properties. [Color gure can be viewed in the online issue, which is available at
wileyonlinelibrary.com.]
DISCUSSION
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CONCLUSIONS
In this study, we showed signicant differences in
mechanical properties between the anterior and posterior sub-regions of the supraspinatus tendon. We
recognized that the SSP tendon comprises two functionally different tendons with different tensile properties. In a future study, it is necessary to evaluate how
best to repair an SSP tendon considering its regionspecic mechanical properties.
REFERENCES
Beck J, Evans D, Tonino PM, Yong S, Callaci JJ. 2012. The biomechanical and histologic effects of platelet-rich plasma on rat rotator cuff repairs. Am J Sports Med 40:20372044.
Bisson LJ, Manohar LM. 2009. A biomechanical comparison of
transosseous-suture anchor and suture bridge rotator cuff
repairs in cadavers. Am J Sports Med 37:19911995.
Davidson J, Burkhart SS. 2010. The geometric classication of rotator cuff tears: A system linking tear pattern to treatment and
prognosis. Arthroscopy 26:417424.
DeOrio JK, Coeld RH. 1984. Results of a second attempt at surgical
repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am
66:563567.
Friel NA, Wang VM, Slabaugh MA, Wang F, Chubinskaya S, Cole BJ.
2013. Rotator cuff healing after continuous subacromial bupivacaine infusion: An in vivo rabbit study. J Shoulder Elbow Surg
22:489499.
Gates JJ, Gilliland J, McGarry MH, Park MC, Acevedo D,
Fitzpatrick MJ, Lee TQ. 2010. Inuence of distinct anatomic
subregions of the supraspinatus on humeral rotation. J Orthop
Res 28:1217.
Gerber C, Fuchs B, Hodler J. 2000. The results of repair of massive
tears of the rotator cuff. J Bone Joint Surg Am 82:505515.
Grimberg J, Diop A, Kalra K, Charousset C, Duranthon LD, Maurel N.
2010. In vitro biomechanical comparison of three different types
of single- and double-row arthroscopic rotator cuff repairs: Analysis of continuous bone-tendon contact pressure and surface
during different simulated joint positions. J Shoulder Elbow Surg
19:236243.
Harryman DT, 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML,
Matsen FA III. 1991. Repairs of the rotator cuff. Correlation of
functional results with integrity of the cuff. J Bone Joint Surg Am
73:982989.
706
Matsuhashi et al.
Huang CY, Wang VM, Pawluk RJ, Bucchieri JS, Levine WN, Bigliani
LU, Mow VC, Flatow EL. 2005. Inhomogeneous mechanical
behavior of the human supraspinatus tendon under uniaxial loading. J Orthop Res 23:924930.
Itoi E, Berglund LJ, Grabowski JJ, Schultz FM, Growney ES, Morrey
BF, An KN. 1995. Tensile properties of the supraspinatus tendon.
J Orthop Res 13:578584.
Jost PW, Khair MM, Chen DX, Wright TM, Kelly AM, Rodeo SA. 2012.
Suture number determines strength of rotator cuff repair. J Bone
Joint Surg Am 94:e100(17).
Kaplan K, ElAttrache NS, Vazquez O, Chen YJ, Lee T. 2011. Knotless
rotator cuff repair in an external rotation model: the importance
of medial-row horizontal mattress sutures. Arthroscopy 27:471
478.
Kim HM, Dahiya N, Teefey SA, Middleton WD, Stobbs G, Steger-May
K, Yamaguchi K, Keener JD. 2010. Location and initiation of
degenerative rotator cuff tears: An analysis of three hundred and
sixty shoulders. J Bone Joint Surg Am 92:10881096.
Kim SY, Boynton EL, Ravichandiran K, Fung LY, Bleakney R, Agur
AM. 2007. Three-dimensional study of the musculotendinous
architecture of supraspinatus and its functional correlations. Clin
Anat 20:648655.
Lake SP, Miller KS, Elliott DM, Soslowsky LJ. 2009. Effect of ber distribution and realignment on the nonlinear and inhomogeneous
mechanical properties of human supraspinatus tendon under longitudinal tensile loading. J Orthop Res 27:15961602.
Lorbach O, Anagnostakos K, Vees J, Kohn D, Pape D. 2010. Threedimensional evaluation of the cyclic loading behavior of different
rotator cuff reconstructions. Arthroscopy 26:S95-S105.