Osteoporosis and Rotator Cuff Tear

Osteoporosis and loss of bone mineral density (BMD) are well known to increase the risk of fractures, but reduced BMD and osteoporosis also play a role in rotator cuff tears. This study from the Journal of Bone and Mineral Research (http://onlinelibrary.wiley.com/doi/10.1002/jbmr.5650100817/abstract) concluded: … a rotator cuff rupture results in permanently reduced BMD in the injured extremity, the reduction being greatest in the proximal parts of the extremity. The observed mean decreases (6% in the proximal humerus, 4% in the humeral shaft, and 3% in the distal forearm of the injured limb) are clinically important with respect to age-related bone loss of 1% per year after the age of peak bone mass. Interestingly, this effect was minimal in patients whose shoulder function had been returned to normal.

This study from the American Journal of Sports Medicine (http://www.ncbi.nlm.nih.gov/pubmed/21813440) confirmed the link between rotator cuff healing and BMD. “However, in the multivariate analysis, only BMD (P = .001), FI of the infraspinatus (P = .01), and the amount of retraction (P = .03) showed a significant relationship with cuff healing failure following arthroscopic rotator cuff repair.”

Along with biologic factors, another crucial issue with reduced BMD and osteoporosis is likely the difficulty with achieving reliable mechanical fixation for rotator cuff repair. Dr. Christian Gerber and his colleagues explored this issue in a study presented in the British Journal of Bone and Joint Surgery (http://www.boneandjoint.org.uk/highwire/filestream/15240/field_highwire_article_pdf/0/371.full-text.pdf ) . They studied the mechanical properties of several methods of rotator cuff tendon anchorage to bone using osteoporotic specimens. 

Click here to watch a video about Osteoporosis and Rotator Cuff Tear - How to Repair Your Shoulder Injury.

They found: The weakest link in the chain was osteoporotic bone. Threads pulled into such bone at moderate loads. Augmentation of the bone surface increased the mean ultimate tensile strength to the threshold of suture failure and they concluded: Any biocompatible material with adequate mechanical properties could be used.

It’s clear that successful healing for patients with reduced BMD or osteoporosis requires the utilization of multiple strategies to increase the strength of the bone as well as the strength of rotator cuff tendon fixation. Some validated strategies that we present in the accompanying video to help increase the strength of fixation and improve healing rates include:

 
Author
Vivek Agrawal, MD

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