title: In vivo microstructural analysis of the humeral greater tuberosity in patients with rotator cuff tears using multidetector row computed tomography.
abstract: BACKGROUND
  In arthroscopic surgery, the suture anchor technique has become popular for rotator cuff repair. Preoperative evaluation of the bone microstructure is of utmost importance because, especially in elderly patients, osteoporotic changes may cause anchor pullout, which results in failure of rotator cuff repair. Many groups have reported humeral microstructural analysis; however, most studies were experiments using porcine specimens or human cadavers. In this study, we used multidetector row computed tomography to successfully perform in vivo evaluation of the bone microstructure of the humeral greater tuberosity in patients with rotator cuff tears.
  
  
  METHODS
  Ten patients were examined. Regions of interest were defined in six quadrants of the greater tuberosity (medial, lateral, and far lateral rows of the anterior and posterior areas). The local bone mineral density and the trabecular microstructural parameters, including the mean bone volume to total volume (BV/TV), trabecular thickness, trabecular separation, and structure model index (SMI), were measured using bone analysis software.
  
  
  RESULTS
  The BV/TV of the posteromedial region was highest and the SMI of the posteromedial region was lowest. These findings suggest that the bone quality of the posteromedial portion is the highest within the greater tuberosity.
  
  
  CONCLUSIONS
  Because the bone quality may be correlated with the pullout strength of suture anchors, our method can help to understand the individual and regional variance in bone quality and may lead to the creation of personalized surgical protocols.
authors.affiliation: Department of Orthopaedic Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8521, Japan. sakayosi@naramed-u.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Akira
authors.initials: A
authors.lastname: Kido
authors.forename: Kazuya
authors.initials: K
authors.lastname: Inoue
authors.forename: Goro
authors.initials: G
authors.lastname: Sakurai
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Hashiuchi
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munemoto
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D001182:Arthroscopy; D015519:Bone Density; D005260:Female; D006801:Humans; D006811:Humerus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010024:Osteoporosis / Q000473:pathology; D017006:Rotator Cuff / Q000000981:diagnostic imaging* / Q000601:surgery; D000070636:Rotator Cuff Injuries; D053441:Suture Anchors; D013536:Suture Techniques