Greater tuberosity morphology is altered in individuals with symptomatic isolated supraspinatus tendon tears.

Abstract

In the presence of an isolated supraspinatus tear, the force applied to the greater tuberosity is reduced, which may lead to bony morphologic changes. Thus, diagnostic or surgical identification of landmarks to properly repair the torn tendon might be difficult if the anatomy of the greater tuberosity is altered. The objectives of the study were to assess the presence of the superior, middle, and inferior facets of the greater tuberosity in individuals with symptomatic isolated supraspinatus tendon tears and the associations between tear size, tear location and presence of each facet. Thirty-seven individuals with symptomatic isolated supraspinatus tendon tears were recruited to participate in the study. Individuals underwent a high-resolution computed tomography scan of the involved shoulder and images were segmented to generate subject specific models of each humerus. The vertices comprising each facet were identified; however, if even a single vertex comprising the facet was missing, the facet was considered altered. Percentage agreement for correctly identifying the presence of each facet was determined using 2 additional observers and 5 randomly selected humeri. Ultrasonography was performed to assess anterior-posterior (AP) tear size and tear location. Outcome parameters included presence of the superior, middle, and inferior facets; AP tear size; and tear location. Point-biserial correlations were used to determine the associations between AP tear size, tear location, and presence of the superior, middle, and inferior facets. Supraspinatus tear size and tear location was 13.1±6.1 mm (range, 1.9-28.3 mm) and 2.0±4.4 mm from the posterior edge of the long head of the biceps tendon (range, 0.0-19.0 mm), respectively. Overall, the superior, middle, and inferior facets were not altered in 24.3%, 29.7%, and 45.9% of individuals, respectively. Percentage agreement between observers was 83.4% on average. No associations were found between tear size or tear location and presence of the superior, middle, or inferior facet (P values ranged from .19 to .74). Individuals with symptomatic isolated supraspinatus tears experience significant alterations in the bony morphology of the greater tuberosity that were irrespective of supraspinatus tear size and location. This information is useful for radiologists and orthopedic surgeons as the altered anatomy may influence the ability to identify important anatomic landmarks during diagnostic imaging or surgical procedures.