The relationship between age, rotator cuff integrity, and osseous microarchitecture of greater tuberosity: Where should we put anchor?

Objective: The aim of this study was to compare the microarchitecture of the greater tuberosity with or without rotator cuff tear and to obtain optimum location for anchor screw insertion for rotator cuff repair. Methods: Twenty-five humeral heads were harvested from 13 male cadavers of mean age 58.4 years, including 6 humeri with rotator cuff tear and 19 intact humeri. Six regions of interest (proximal, intermediate, and distal zones of the superficial and deep regions) were divided into the anterior (G1), middle (G2), and posterior (G3) areas of the greater tuberosity. Trabecular bone volume and cortical thickness were evaluated. Results: Total trabecular bone volume was greater in subjects <50 years old than in subjects >50 years old but did not differ significantly in subjects with and without rotator cuff tear. Cortical thickness in both intact and torn rotator cuff groups was significantly greater in the proximal and intermediate zones than in the distal zone. Cortical thickness was related to anatomic location rather than age or cuff tear. Conclusion: The optimal location for anchor screw insertion during rotator cuff repair is either the proximal or intermediate region of the greater tuberosity. Age has more influence in terms of trabecular bone volume loss than rotator cuff integrity.