Mason Garcia, Gabriel Landi, Bailee Covan, Daniela Caro, Mohammad Khak, Ahmad Hedayatzadeh Razavi, Joseph P. DeAngelis, Arun J. Ramappa, Ara Nazarian
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Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1 cm, equivalent to 20-30% of the tendon width) and medium-sized (1–3 cm, equivalent to 40–50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes.</p></div>","PeriodicalId":7986,"journal":{"name":"Annals of Biomedical Engineering","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of Tear Size and Location on Supraspinatus Tendon Strain During Activities of Daily Living and Physiotherapy\",\"authors\":\"Mason Garcia, Gabriel Landi, Bailee Covan, Daniela Caro, Mohammad Khak, Ahmad Hedayatzadeh Razavi, Joseph P. DeAngelis, Arun J. Ramappa, Ara Nazarian\",\"doi\":\"10.1007/s10439-024-03538-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p>The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1 cm, equivalent to 20-30% of the tendon width) and medium-sized (1–3 cm, equivalent to 40–50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. 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引用次数: 0
摘要
冈上肌腱在肩部外展中起着至关重要的作用,因此是常见的受伤结构之一。在临床上,新月形撕裂是最常见的撕裂形状。本研究通过建立六种具有异质材料特性的冈上-冈下三维有限元模型,旨在研究冈上肌腱的组织变形(最大主应变)因特定材料特性和肩袖撕裂大小而产生的变化。研究人员对具有中小型全厚度新月形撕裂的 FE 模型施加了日常生活和物理治疗过程中可见的载荷。解剖了六具新鲜冷冻的尸体肩部,对冈上肌腱进行机械测试,并开发和验证了可用于评估位于冈上肌腱中部和后部区域的小型(< 1 厘米,相当于肌腱宽度的 20-30%)和中型(1-3 厘米,相当于肌腱宽度的 40-50%)撕裂引起的应变变化的 FE 模型。对撕裂尖端最大主应变的 FE 预测进行了检查,以确定在日常生活活动(喝水和刷牙)和理疗运动(俯卧外展和外旋 90°)中是否达到了失效应变。对于中小型撕裂,中间和后部撕裂的失效负荷没有明显差异。在俯卧外展运动中,冈上肌腱中部和后部的中等大小撕裂存在着撕裂恶化(超过失效应变)的潜在风险。在外展 90° 的外旋运动中,有一个中间撕裂的模型和两个后部撕裂的模型出现了失效。在所有日常活动负荷下,应变从未超过失效应变。我们的三维冈上-冈下 FE 模型显示,根据区域应变反应,小的撕裂似乎不太可能恶化;但是,中等大小的撕裂在更剧烈的理疗运动中风险更高。此外,患者特定肌腱材料特性的差异也是决定撕裂是否会发展的重要因素。因此,根据撕裂大小制定针对患者的管理计划可能有利于改善临床疗效。
Effect of Tear Size and Location on Supraspinatus Tendon Strain During Activities of Daily Living and Physiotherapy
The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1 cm, equivalent to 20-30% of the tendon width) and medium-sized (1–3 cm, equivalent to 40–50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes.
期刊介绍:
Annals of Biomedical Engineering is an official journal of the Biomedical Engineering Society, publishing original articles in the major fields of bioengineering and biomedical engineering. The Annals is an interdisciplinary and international journal with the aim to highlight integrated approaches to the solutions of biological and biomedical problems.