Tension Distribution in Articular Surfaces of the Rotator Cable and Crescent: A Cadaveric Study.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
04 Apr 2024
04 Apr 2024
Historique:
medline:
4
4
2024
pubmed:
4
4
2024
entrez:
4
4
2024
Statut:
aheadofprint
Résumé
The rotator cable functions as a stress and/or load transfer structure. Some studies suggested that a disruption of the cable negatively affects shoulder function and tendon integrity in patients with rotator cuff tears, while others found no functional impairment regardless of rotator cable tear severity. Although anatomical studies have identified distinct regions within the rotator cuff muscles, the strain distribution within the articular sides of the rotator cuff tendons that results from the tension in each region remains unknown. We hypothesized that the posterior region of the supraspinatus (SSP) muscle and the middle region of the infraspinatus (ISP) muscle, with their firm capsular attachments to the cable, transmit 3D strains, and thus tension, to the whole cable, leading to differences in tension within the cable. The 3D strain distributions in the articular sides of the SSP and ISP tendons of 8 fresh-frozen cadaveric intact shoulders were determined when tension was applied to the various SSP and ISP muscle regions. Loading the anterior SSP muscle region yielded significantly higher strains in the anterior third of the cable compared with the posterior third (p < 0.05). Loading the posterior SSP muscle region yielded no significant differences among the cable and crescent regions. Loading the middle ISP muscle region yielded higher strains in the anterior and posterior thirds of the cable compared with the middle third (p < 0.01). Loading the superior ISP muscle region yielded no significant differences among the cable and crescent regions (p > 0.05). Tension generated from the posterior region of the SSP muscle and middle region of the ISP muscle was evenly distributed to the anterior and posterior attachments of the rotator cable, while the tension generated from other SSP and ISP muscle regions was locally transmitted to the respective attachment area. The rotator cable and crescent serve pivotal roles in transmitting tension generated from the deep regions of the rotator cuff muscles, i.e., the posterior SSP and middle ISP. These findings indicate that both the rotator cable and the rotator crescent play crucial roles as tension transmitters for the deep regions of the rotator cuff muscles. This information could have important implications for developing anatomically relevant repair techniques and enhancing rehabilitation protocols.
Sections du résumé
BACKGROUND
BACKGROUND
The rotator cable functions as a stress and/or load transfer structure. Some studies suggested that a disruption of the cable negatively affects shoulder function and tendon integrity in patients with rotator cuff tears, while others found no functional impairment regardless of rotator cable tear severity. Although anatomical studies have identified distinct regions within the rotator cuff muscles, the strain distribution within the articular sides of the rotator cuff tendons that results from the tension in each region remains unknown. We hypothesized that the posterior region of the supraspinatus (SSP) muscle and the middle region of the infraspinatus (ISP) muscle, with their firm capsular attachments to the cable, transmit 3D strains, and thus tension, to the whole cable, leading to differences in tension within the cable.
METHODS
METHODS
The 3D strain distributions in the articular sides of the SSP and ISP tendons of 8 fresh-frozen cadaveric intact shoulders were determined when tension was applied to the various SSP and ISP muscle regions.
RESULTS
RESULTS
Loading the anterior SSP muscle region yielded significantly higher strains in the anterior third of the cable compared with the posterior third (p < 0.05). Loading the posterior SSP muscle region yielded no significant differences among the cable and crescent regions. Loading the middle ISP muscle region yielded higher strains in the anterior and posterior thirds of the cable compared with the middle third (p < 0.01). Loading the superior ISP muscle region yielded no significant differences among the cable and crescent regions (p > 0.05).
CONCLUSIONS
CONCLUSIONS
Tension generated from the posterior region of the SSP muscle and middle region of the ISP muscle was evenly distributed to the anterior and posterior attachments of the rotator cable, while the tension generated from other SSP and ISP muscle regions was locally transmitted to the respective attachment area.
CLINICAL RELEVANCE
CONCLUSIONS
The rotator cable and crescent serve pivotal roles in transmitting tension generated from the deep regions of the rotator cuff muscles, i.e., the posterior SSP and middle ISP. These findings indicate that both the rotator cable and the rotator crescent play crucial roles as tension transmitters for the deep regions of the rotator cuff muscles. This information could have important implications for developing anatomically relevant repair techniques and enhancing rehabilitation protocols.
Identifiants
pubmed: 38574117
doi: 10.2106/JBJS.23.01270
pii: 00004623-990000000-01062
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: This study was internally funded by The University of Texas at San Antonio. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H957).
Références
Burkhart SS, Esch JC, Jolson RS. The rotator crescent and rotator cable: an anatomic description of the shoulder’s “suspension bridge”. Arthroscopy. 1993;9(6):611-6.
Mesiha MM, Derwin KA, Sibole SC, Erdemir A, McCarron JA. The biomechanical relevance of anterior rotator cuff cable tears in a cadaveric shoulder model. J Bone Joint Surg Am. 2013 Oct 16;95(20):1817-24.
Cho NS, Moon SC, Hong SJ, Bae SH, Rhee YG. Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable. Am J Sports Med. 2017 Sep;45(11):2532-9.
Denard PJ, Koo SS, Murena L, Burkhart SS. Pseudoparalysis: the importance of rotator cable integrity. Orthopedics. 2012 Sep;35(9):e1353-7.
Wang L, Kang Y, Xie G, Cai J, Chen C, Yan X, Jiang J, Zhao J. Incomplete Rotator Cable Did Not Cause Rotator Cuff Dysfunction in Case of Rotator Cuff Tear: A Biomechanical Study of the Relationship Between Rotator Cable Integrity and Rotator Cuff Function. Arthroscopy. 2021 Aug;37(8):2444-51.
Andarawis-Puri N, Kuntz AF, Kim SY, Soslowsky LJ. Effect of anterior supraspinatus tendon partial-thickness tears on infraspinatus tendon strain through a range of joint rotation angles. J Shoulder Elbow Surg. 2010 Jun;19(4):617-23.
Andarawis-Puri N, Kuntz AF, Ramsey ML, Soslowsky LJ. Effect of glenohumeral abduction angle on the mechanical interaction between the supraspinatus and infraspinatus tendons for the intact, partial-thickness torn, and repaired supraspinatus tendon conditions. J Orthop Res. 2010 Jul;28(7):846-51.
Andarawis-Puri N, Ricchetti ET, Soslowsky LJ. Interaction between the supraspinatus and infraspinatus tendons: effect of anterior supraspinatus tendon full-thickness tears on infraspinatus tendon strain. Am J Sports Med. 2009 Sep;37(9):1831-9.
Schmidt CC, Spicer CS, Papadopoulos DV, Delserro SM, Tomizuka Y, Zink TR, Blake RJ, Smolinski MP, Miller MC, Greenwell JM, Carrazana-Suarez LF, Smolinski PJ. The Rotator Cable Does Not Stress Shield the Crescent Area During Shoulder Abduction. J Bone Joint Surg Am. 2022 Jul 20;104(14):1292-300.
Yuri T, Prado M, Trevino JH 3rd, Giambini H. Strain distribution in the bursal rotator cuff based on whole-muscle and muscle subregion-specific loading: A cadaveric study. J Orthop Res. 2023 Sep;41(9):1863-70.
Bacle G, Gregoire JM, Patat F, Clavert P, de Pinieux G, Laulan J, Lakhal W, Favard L. Anatomy and relations of the infraspinatus and the teres minor muscles: a fresh cadaver dissection study. Surg Radiol Anat. 2017 Feb;39(2):119-26.
Roh MS, Wang VM, April EW, Pollock RG, Bigliani LU, Flatow EL. Anterior and posterior musculotendinous anatomy of the supraspinatus. J Shoulder Elbow Surg. 2000 Sep-Oct;9(5):436-40.
Rahu M, Kolts I, Põldoja E, Kask K. Rotator cuff tendon connections with the rotator cable. Knee Surg Sports Traumatol Arthrosc. 2017 Jul;25(7):2047-50.
Yuri T, Kobayashi H, Takano Y, Yoshida S, Naito A, Fujii H, Kiyoshige Y. Capsular attachment of the subregions of rotator cuff muscles. Surg Radiol Anat. 2019 Nov;41(11):1351-9.
Yuri T, Trevino JH 3rd, Hooke A, Giambini H. Moment arms from the anatomical subregions of the rotator cuff muscles during flexion. J Biomech. 2022 Nov;144:111340.
Yuri T, Trevino JH 3rd, Hoshikawa K, Hooke A, Giambini H. Moment arms of the anatomical subregions of the rotator cuff muscles during shoulder rotation. Clin Biomech (Bristol, Avon). 2023 Jul;107:106040.
Hermenegildo JA, Roberts SL, Kim SY. Innervation pattern of the suprascapular nerve within supraspinatus: a three-dimensional computer modeling study. Clin Anat. 2014 May;27(4):622-30.
Halder A, Zobitz ME, Schultz F, An KN. Mechanical properties of the posterior rotator cuff. Clin Biomech (Bristol, Avon). 2000 Jul;15(6):456-62.
Huang CY, Wang VM, Pawluk RJ, Bucchieri JS, Levine WN, Bigliani LU, Mow VC, Flatow EL. Inhomogeneous mechanical behavior of the human supraspinatus tendon under uniaxial loading. J Orthop Res. 2005 Jul;23(4):924-30.
Matsuhashi T, Hooke AW, Zhao KD, Goto A, Sperling JW, Steinmann SP, An KN. Tensile properties of a morphologically split supraspinatus tendon. Clin Anat. 2014 Jul;27(5):702-6.
Alenabi T, Whittaker R, Kim SY, Dickerson CR. Maximal voluntary isometric contraction tests for normalizing electromyographic data from different regions of supraspinatus and infraspinatus muscles: Identifying reliable combinations. J Electromyogr Kinesiol. 2018 Aug;41:19-26.
Hoshikawa K, Yuri T, Giambini H, Kiyoshige Y. Shoulder scaption is dependent on the behavior of the different partitions of the infraspinatus muscle. Surg Radiol Anat. 2021 May;43(5):653-9.
Hoshikawa K, Yuri T, Giambini H, Mura N, Kiyoshige Y. The functional role of the supraspinatus and infraspinatus muscle sub-regions during forward flexion: a shear wave elastography study. JSES Int. 2022 Jun 27;6(5):849-854.
Trevino Iii JH, Yuri T, Hatta T, Kiyoshige Y, Jacobs PM, Giambini H. Three-dimensional quantitative measurements of atrophy and fat infiltration in sub-regions of the supraspinatus muscle show heterogeneous distributions: a cadaveric study. Arch Orthop Trauma Surg. 2022 Jul;142(7):1395-403.
Yuri T, Kuwahara Y, Fujii H, Kiyoshige Y. Functions of the subregions of the supraspinatus muscle. Clin Anat. 2017 Apr;30(3):347-51.
Halder AM, O’Driscoll SW, Heers G, Mura N, Zobitz ME, An KN, Kreusch-Brinker R. Biomechanical comparison of effects of supraspinatus tendon detachments, tendon defects, and muscle retractions. J Bone Joint Surg Am. 2002 May;84(5):780-5.
Mattar LT, Popchak AJ, Musahl V, Lin A, Irrgang JJ, Debski RE. Greater tuberosity morphology is altered in individuals with symptomatic isolated supraspinatus tendon tears. J Shoulder Elbow Surg. 2023 Dec;32(12):2467-72.