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Archives of Orthopaedic and Trauma Surgery

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01-03-2013 | Arthroscopy and Sports Medicine

X-treme CT analysis of cancellous bone at the rotator cuff insertion in human individuals with osteoporosis: superficial versus deep quality

Authors: Chlodwig Kirchhoff, Sonja Kirchhoff, Christoph M. Sprecher, Philipp Ahrens, Andreas B. Imhoff, Stefan Hinterwimmer, Stefan Milz, Volker Braunstein

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 3/2013

Abstract

Purpose

Rotator cuff (RC) repair—especially in the elderly population—is problematic since the patients suffer to a high extent from bone mineral density loss at the reattachment site. Therefore, the study was primarily driven by the question whether it is possible to reach more or qualitatively better cancellous bone and thus a more stable postoperative result if anchors with greater length are used for RC repair and/or the conventional anchors are screwed deeper into the bone. In anatomical terms, the question is raised whether cancellous bone is of better quality close to or far off the RC enthesis.

Methods

Axial HRqCT scans (X-tremeCT, Scanco Medical) of 36 human cadaveric humeral heads (75 ± 11 years) were performed to determine the ratio of bone volume to total volume (BV/TV), trabecular thickness (Trab Th), number of trabecles (Trab N), trabecular separation (Trab Sp) as well as non-metric indices such as connectivity density (Conn Dens) and structure model index (SMI). Within the greater tuberosity (GT), 6 volumes of interest (VOI) (A1, B1, C1, A2, B2, C2), in the lesser tuberosity (LT) 2 VOIs (D1, D2) and one control VOI in the subchondral bone were set. The analyzed bone cylinder of each VOI was divided into a superficial and a deep portion.

Results

The parameters BV/TV, Trab N, Trab Th and Conn Dens in all volumes of the GT and LT revealed higher values in the superficial portion reaching different levels of significance (p < 0.001/<0.05). The only parameter presenting a higher value in the deep portion was Trab Sp, but this was the case for all GT and LT regions. Interestingly, the difference between the superficial and deep portion reached significance for the non-metric parameter SMI in no volume of the GT/LT, although the higher values were found superficially.

Conclusions

Our data show that cancellous bone presents with decreasing bone quality when analyzing increasingly deeper portions of the bone cylinders of the GT and LT starting at the articular surface. This information seems to be crucial for shoulder surgeons, especially when treating elderly patients. Our results clearly prove that screwing in anchors to a deeper extent will not improve stability, since the deeper bone stock is of worse quality.

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Title: X-treme CT analysis of cancellous bone at the rotator cuff insertion in human individuals with osteoporosis: superficial versus deep quality
Authors: Chlodwig Kirchhoff
Sonja Kirchhoff
Christoph M. Sprecher
Philipp Ahrens
Andreas B. Imhoff
Stefan Hinterwimmer
Stefan Milz
Volker Braunstein
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 3/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1663-8

2024 ASCO Annual Meeting

Springer Medicine

X-treme CT analysis of cancellous bone at the rotator cuff insertion in human individuals with osteoporosis: superficial versus deep quality

Abstract

Purpose

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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