Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Arthroscopic evaluation of the rotator cuff vasculature: inferences into the pathogenesis of cuff tear and re-tear

  • Steafano Gumina (Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome) ;
  • Hyun Seok Song (Department of Orthopaedics Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hyungsuk Kim (Department of Orthopaedics Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Vittorio Candela (Department of Anatomical, Histological, Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, Umberto I Polyclinic of Rome)
  • Received : 2024.01.24
  • Accepted : 2024.03.28
  • Published : 2024.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Little is known about alterations of the rotator cuff (RC) macroscopic vasculature associated with medical conditions and/or habits that predispose a person to diseases of the peripheral microcirculation. The high frequency of cuff tear and re-tear in patients with diabetes, hypercholesterolemia, uncontrolled arterial hypertension, or metabolic syndrome may be due to tissue hypovascularity. Methods: The macroscopic vasculature of both the articular and bursal sides of the posterosuperior RC was evaluated arthroscopically in 107 patients (mean age, 58.2 years) with no RC tear. Patients were divided into three groups according to medical comorbidities and lifestyle factors (group I, none; group II, smokers and/or drinkers and one comorbidity; and group III, two or more comorbidities). Pulsating vessels originating from both the myotendinous and osteotendinous junctions were assessed as "clearly evident," "poorly evident," or "not evident." Results: Groups I, II, and III comprised 36, 45, and 26 patients, respectively. Within the myotendinous junction, vessels were visualized in 22 group I patients (61%), 25 group II patients (55%), and 6 group III patients (23%) (P=0.007). Pulsating arterial vessels originating from the osteotendinous junction were seen in 42%, 36%, and 0% of patients, respectively (P<0.001). Within the bursal side of the RC, a dense anastomotic network was visualized (either clearly or poorly) in 94% (34), 80% (36), and 35% (9) of patients, respectively (P<0.001). Conclusions: The macroscopic vasculature of the RC is influenced by pre-existing diseases and lifestyle factors, which may impair peripheral microcirculation.

Keywords

References

  1. Nichols AE, Oh I, Loiselle AE. Effects of type II diabetes mellitus on tendon homeostasis and healing. J Orthop Res 2020;38:13-22.
  2. Thomas SJ, McDougall C, Brown ID, et al. Prevalence of symptoms and signs of shoulder problems in people with diabetes mellitus. J Shoulder Elbow Surg 2007;16:748-51.
  3. Lin TT, Lin CH, Chang CL, Chi CH, Chang ST, Sheu WH. The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study. Am J Sports Med 2015;43:2126-32.
  4. Abboud JA, Kim JS. The effect of hypercholesterolemia on rotator cuff disease. Clin Orthop Relat Res 2010;468:1493-7.
  5. Ronnemaa T, Juva K, Kulonen E. Effect of hyperlipidemic rat serum on the synthesis of collagen by chick embryo fibroblasts. Atherosclerosis 1975;21:315-24.
  6. Rothman RH, Parke WW. The vascular anatomy of the rotator cuff. Clin Orthop Relat Res 1965;41:176-86.
  7. Gumina S, Arceri V, Carbone S, et al. The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg 2013;22:229-32.
  8. Wendelboe AM, Hegmann KT, Gren LH, Alder SC, White GL Jr, Lyon JL. Associations between body-mass index and surgery for rotator cuff tendinitis. J Bone Joint Surg Am 2004;86:743-7.
  9. Gumina S, Candela V, Passaretti D, et al. The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg 2014;23:1669-74.
  10. Baumgarten KM, Gerlach D, Galatz LM, et al. Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res 2010;468:1534-41.
  11. Mallon WJ, Misamore G, Snead DS, Denton P. The impact of preoperative smoking habits on the results of rotator cuff repair. J Shoulder Elbow Surg 2004;13:129-32.
  12. Carbone S, Gumina S, Arceri V, Campagna V, Fagnani C, Postacchini F. The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes. J Shoulder Elbow Surg 2012;21:56-60.
  13. Passaretti D, Candela V, Venditto T, Giannicola G, Gumina S. Association between alcohol consumption and rotator cuff tear. Acta Orthop 2016;87:165-8.
  14. Gumina S, Mezzaqui L, Aimino R, et al. Aetiopathogenesis of rotator cuff tear in patients younger than 50 years: medical conditions play a relevant role. Medicina (Kaunas) 2023;59:998.
  15. Poldoja E, Rahu M, Kask K, Weyers I, Kolts I. Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side. Knee Surg Sports Traumatol Arthrosc 2017;25:2041-6.
  16. Ling SC, Chen CF, Wan RX. A study on the vascular supply of the supraspinatus tendon. Surg Radiol Anat 1990;12:161-5.
  17. de la Garza O, Lierse W, Steiner D. Anatomical study of the blood supply in the human shoulder region. Acta Anat (Basel) 1992;145:412-5.
  18. Notarnicola A, Fischetti F, Gallone D, et al. Overload and neovascularization of shoulder tendons in volleyball players. BMC Res Notes 2012;5:397.
  19. Chansky HA, Iannotti JP. The vascularity of the rotator cuff. Clin Sports Med 1991;10:807-22.
  20. Keough N, de Beer T, Uys A, Hohmann E. An anatomical investigation into the blood supply of the proximal humerus: surgical considerations for rotator cuff repair. JSES Open Access 2019;3:320-7.
  21. Determe D, Rongieres M, Kany J, et al. Anatomic study of the tendinous rotator cuff of the shoulder. Surg Radiol Anat 1996;18:195-200.
  22. Lohr JF, Uhthoff HK. The microvascular pattern of the supraspinatus tendon. Clin Orthop Relat Res 1990;(254):35-8.
  23. Brooks CH, Revell WJ, Heatley FW. A quantitative histological study of the vascularity of the rotator cuff tendon. J Bone Joint Surg Br 1992;74:151-3.
  24. Jobe CM. Gross anatomy of the shoulder. In: Rockwood CA, Matsen FA, eds. The shoulder. WB Saunders; 1990. p. 60-1.
  25. Bonnevialle N, Bayle X, Projetti F, Wargny M, Gomez-Brouchet A, Mansat P. Variations of the micro-vascularization of the greater tuberosity in patients with rotator cuff tears. Int Orthop 2015;39:371-6.
  26. Snyder SJ. Diagnostic arthroscopy of the shoulder: normal anatomy and variations. In: Snyder SJ, ed. Shoulder arthroscopy. 2nd ed. Lippincott Williams & Wilkins; 2002. p. 26.
  27. Ambrosino P, Grassi G, Maniscalco M. Endothelial dysfunction: from a pathophysiological mechanism to a potential therapeutic target. Biomedicines 2021;10:78.
  28. Zeiher AM, Drexler H, Wollschlager H, Just H. Modulation of coronary vasomotor tone in humans: progressive endothelial dysfunction with different early stages of coronary atherosclerosis. Circulation 1991;83:391-401.
  29. Berenyiova A, Bernatova I, Zemancikova A, et al. Vascular effects of low-dose ACE2 inhibitor MLN-4760-benefit or detriment in essential hypertension. Biomedicines 2021;10:38.
  30. Vane JR, Anggard EE, Botting RM. Regulatory functions of the vascular endothelium. N Engl J Med 1990;323:27-36.
  31. Tare M, Parkington HC, Coleman HA, Neild TO, Dusting GJ. Hyperpolarization and relaxation of arterial smooth muscle caused by nitric oxide derived from the endothelium. Nature 1990;346:69-71.
  32. Feletou M, Vanhoutte PM. Endothelial dysfunction: a multifaceted disorder (The Wiggers Award Lecture). Am J Physiol Heart Circ Physiol 2006;291:H985-1002.
  33. Ambrosino P, Lupoli R, Iervolino S, et al. Clinical assessment of endothelial function in patients with chronic obstructive pulmonary disease: a systematic review with meta-analysis. Intern Emerg Med 2017;12:877-85.
  34. Rathbun JB, Macnab I. The microvascular pattern of the rotator cuff. J Bone Joint Surg Br 1970;52:540-53.
  35. Wall LB, Keener JD, Brophy RH. Double-row vs single-row rotator cuff repair: a review of the biomechanical evidence. J Shoulder Elbow Surg 2009;18:933-41.
  36. Milano G, Grasso A, Zarelli D, Deriu L, Cillo M, Fabbriciani C. Comparison between single-row and double-row rotator cuff repair: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2008;16:75-80.
  37. Kim DH, Elattrache NS, Tibone JE, et al. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 2006;34:407-14.
  38. Meier SW, Meier JD. Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg 2006;15:691-6.
  39. Smith CD, Alexander S, Hill AM, et al. A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am 2006;88:2425-31.
  40. Khoriati AA, Antonios T, Gulihar A, Singh B. Single vs double row repair in rotator cuff tears: a review and analysis of current evidence. J Clin Orthop Trauma 2019;10:236-40.
  41. Lapner P, Henry P, Athwal GS, et al. Treatment of rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022;31:e120-9.
  42. Sethi PM, Sheth CD, Pauzenberger L, et al. Macroscopic rotator cuff tendinopathy and histopathology do not predict repair outcomes of rotator cuff tears. Am J Sports Med 2018;46:779-85.
  43. Chung SW, Oh JH, Gong HS, Kim JY, Kim SH. Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med 2011;39:2099-107.
  44. Gumina S, Villani C, Arceri V, et al. Rotator cuff degeneration: the role of genetics. J Bone Joint Surg Am 2019;101:600-5.