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The Biomechanical Relevance of Anterior Rotator Cuff Cable Tears in a Cadaveric Shoulder Model
Mena M. Mesiha, MD1; Kathleen A. Derwin, PhD1; Scott C. Sibole, BS1; Ahmet Erdemir, PhD1; Jesse A. McCarron, MD2
1 Department of Orthopaedic Surgery, A41 (M.M.M.), and Department of Biomedical Engineering, ND2-20 (K.A.D., S.C.S., and A.E.), Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail address for M.M. Mesiha: mesiham@gmail.com
2 Orthopaedic Surgery Section, Department of Veterans Affairs Medical Center, Portland Division, 3710 S.W. U.S. Veterans Hospital Road, P.O. Box 1034, P3OC, Portland, OR 97207
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A commentary by Xavier A. Duralde, MD, is linked to the online version of this article at jbjs.org.

Investigation performed at the Cleveland Clinic, Cleveland, Ohio

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Oct 16;95(20):1817-1824. doi: 10.2106/JBJS.L.00784
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Anterior tears of the supraspinatus tendon are more likely to be clinically relevant than posterior tears of the supraspinatus. We hypothesized that anterior tears of the supraspinatus tendon involving the rotator cuff cable insertion are associated with greater tear gapping, decreased tendon stiffness, and increased regional tendon strain under physiologic loading conditions compared with equivalently sized tears of the rotator cuff crescent.


Twelve human cadaveric shoulders were randomized to undergo simulation of equivalently sized supraspinatus tears of either the anterior rotator cuff cable (n = 6) or the adjacent rotator cuff crescent (n = 6). For each specimen, the supraspinatus tendon was cyclically loaded from 10 N to 180 N, and a custom three-dimensional optical system was used to track markers on the surface of the tendon. Tear gap distance, stiffness, and regional strains of the supraspinatus tendon were calculated.


The tear gap distance of large cable tears (median gap distance, 5.2 mm) was significantly greater than that of large crescent tears (median gap distance, 1.3 mm) (p = 0.002), the stiffness of tendons with a small (p = 0.002) or large (p = 0.002) cable tear was significantly greater than that of tendons with equivalently sized crescent tears, and regional strains across the supraspinatus were significantly increased in magnitude and altered in distribution by tears involving the anterior insertion of the rotator cuff cable.


These findings support our hypothesis that the rotator cuff cable, which is in the most anterior 8 to 12 mm of the supraspinatus tendon immediately posterior to the bicipital groove, is the primary load-bearing structure within the supraspinatus for force transmission to the proximal part of the humerus. Conversely, in the presence of an intact rotator cuff cable, the rotator cuff crescent insertion is relatively stress-shielded and plays a significantly lesser role in supraspinatus force transmission.

Clinical Relevance: 

Clinicians should consider early repair of rotator cuff cable tears, which may need surgical intervention to address their biomechanical pathology. In contrast, surgical treatment may be more safely delayed for rotator cuff crescent tears.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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