33RD ANNUAL MEETING OF THE JAPAN SHOULDER SOCIETY 001 An Anatomical Study of the Subscapularis Insertion to the sis of the tendon in the articular side were significantly higher in both Humerus mature (p ¼ 0.02) and aged (p ¼ 0.014) rabbits. However, the sta- Tokiyoshi Akinari, Ide Junji, Hirose Jun, Mizuta Hiroshi, Department tistical trend, in which the collagen synthesis of the articular side de- of Orthopaedic Surgery, Graduate School of Medical Sciences, creased with age, was observed (p ¼ 0.058). The collagen Kumamoto University synthesis of the tendon in the articular side was significantly higher Recently many rotator cuff tears including subscapularis are re- regardless of age. A more active turn over of collagen might be re- paired arthroscopically. However, there are only a few reports about quired for the tendon in the articular side. The decrease of collagen the morphology of the subsccapularis muscle insertion to the hu- synthesis of the tendon on the articular side with age might induce merus. The knowledge of the insertion morphology leads to appreci- the degeneration of a rotator cuff tendon from the articular side, re- ate the tear size and to repair anatomically. In this study, we sulting in an articular side tear. investigated the cadaveric shoulders to clarify the morphology of the subscapularis muscle insertion and the difference between sexes and sides. We investigated 24 cadaveric shoulders (bilateral shoul- ders of five males and seven females; mean age 87 years old) and 003 Gene Expression after Administration of TGF-b1 on Cells measured the maximum longitudinal distance (proximal-to-distal di- Derived from the Rotator Cuff rection) and transverse distance (medial-to-lateral direction) of the Yamaguchi Hiroshi, Department of Orthopaedic Surgery, The subscapularis insertion. We also measured the distance between University of Ryukyus School of Medicine the articular cartilage edge and the most medial tendon insertion Suenaga Naoki, Minami Akio, Department of Orthopaedic Sur- (bare area) at sites of the proximal end, maximum transverse dis- gery, Hokkaido University School of Medicine tance position and the distal end. The data were analyzed with an Sonnabend David H, Department of Orthopaedic and Trauma unpaired-t-test or paired-t-test between sexes and sides. Statistical sig- Surgery, Royal North Shore Hospital, The University of Sydney nificance was set at p < 0.05. The subscapularis muscle insertion Although good mid-term clinical results after a rotator cuff repair was consisted of 2 parts, proximal tendinous part and distal muscular have been reported on, it was pointed out that complete tendon re- part in all cadavers. The mean maximum longitudinal distance of the attachment to the humerus is very difficult. The aim of the present tendon insertion was 35.5 (SD, 4.2) mm. The mean transverse dis- study was to investigate the effect of TGF-b1 on a sheep infraspinatus tance of the tendon insertion was 15.8 (SD, 2.3) mm. The mean dis- tendon cell cultured on Polyglactin910. The cells derived from tance of the bare area at sites of the proximal end, maximum a sheep infraspinatus tendon by an enzyme digestion method transverse distance position and the distal end was 3.1 (SD, 2.0) were cultured for 10 days. mm, 5.9 (SD, 1.7) mm, 11.9 (SD, 3.4) mm, respectively. Significant After the culture, expression of genes were investigated by RT- differences existed between sexes in maximum transverse distance PCR methods after the extraction of RNA with TRIzole treatment. (p ¼ 0.0006), the bare area at the maximum transverse distance po- Evaluated genes were type 1 and 3 collagen, MMP-1 and MMP- sition (p ¼ 0.00199) and distal end position (p ¼ 0.0015). No sig- 13, Aggrecan, Biglycan, Decorin, Fibromodulin, Lumican, Elastin, nificant differences were found between sides in all subjects. We Osteopontin. Statical comparisons were performed using one-way examined the subscapularis insertion to the humerus in cadaveric analysis of variance and Fisher PLSD tests. Differences were consid- shoulders. Anatomical measurements in this study may be useful in ered significant for less than 5%. In results, mRNA expression was evaluating and reattaching the subscapularis to the humerus. significantly increased for type 1 collagen, Aggrecan, Elastin. Espe- cially, type 1 collagen, Elastin were revealed a dose dependent pos- itive effect. mRNA expression was, however, significantly decreased for MMP-1, Lumican. 002 Aging Induces Less Collagen Synthesis on the These results indicated that TGF-b1 may have a significant effect Supraspinatus Tendon in the Rabbit on rotator cuff healing and stimulus for further studies in this field. Takahashi Norimasa, Department of Orthopaedic surgery, Kohno- dai Hospital, National Center of Neurology and Psychiatry, SANO Sakae, Matsudo City Hospital Ochiai Nobuyasu, Department of Orthopaedics, University of Cali- 004 Behavior of Host and Graft Cells in Early Remodeling fornia, San Diego Process After Tendon Transplantation For The Rotator Cuff Saisu Takashi, Chiba Children’s Hospital Defect Moriishi Joji, Funabashi Orthopaedic Sports Medicine Center Iwata Yoshio, Morihara Toru, Tachiiri Hisakazu, Fujiwara Hiroyoshi, Because of the poor vascularity of the supraspinatus tendon in Kubo Toshikazu, Department of Orthopaedics, Graduate School of the articular side, the degeneration of the tendon was considered Medical Science, Kyoto Prefectural University of Medicine to start from the articular side. To understand the pathology of a rota- Horii Motoyuki, Department of Orthopaedic Surgery, Kyoto Interdis- tor cuff tear, we assessed the effect of aging on the collagen synthe- ciplinary Institute Hospital of Community Medicine sis of the tenocyte in supraspinatus tendon in the rabbit. 12 New Kurokawa Masao, Department of Orthopaedic Surgery, Saiseikai Zeeland white rabbits were used, which included 6 mature rabbits Suita Hospital aged 1 year old and 6 aged rabbits aged 4-5 year old. After their The purpose of this study is to examine the behavior of the host sacrifice, the supraspinatus tendons were harvested immediately and graft cells in early remodeling process after tendon implantation and trimmed to the rectangular shape of 4 mm x 8 mm. They were to the defect using green fluorescent protein (GFP) transgenic rat. 20 divided into two pieces, which included the articular side surface Sprague Dawley (SD) rats and 20 green fluorescent protein (GFP) and the bursal side surface. They were placed in to cell culture me- transgenic rats were used in this study. Tendinous defect were dia containing [3H]-proloine (5 mci/ml of media) and incubated at made close to the supraspinatus tendon insertion. In group A, the 37C for 48 hours. Following incubation, [3H]-hydroxyproline (col- Achilles tendons of SD rats were transplanted into the defect of lagen synthesis) was quantified by HPLC after acid hydrolysis. The GFP rats. In group B, the Achilles tendons of GFP rats were trans- data were compared to each group using t-test. The collagen synthe- planted into the defect of SD rats. At 0,1,3,7 and 28 days after e1 e2 Abstracts J Shoulder Elbow Surg surgery, sections stained with hematoxylin and eosin were assessed 6 0.88, massive: -1.66 respectively. The smaller difference be- histologically, and localization of GFP positive cells were also eval- tween superficial tears and deep tears with delamination were ob- uated. The graft was surrounded by inflammatory cells at 3 days. At served in the larger sizes of superficial tears. The smaller the bone-tendon insertion, fibroblastic cells started to infiltrate histo- difference between superficial tears and deep tears with delamina- logically and increased in number in 28 days. In Group A, a small tion were observed in the larger sizes of superficial tears. number of signal positive host cells were found around both the bur- sal and articular side of grafted tendon at 1 day. The host cells in- creased at 7 days. In Group B, signal positive graft cells were found in the graft at 1 day, which decreased over time. Replacement 011 Optimal Humerus Positioning when Evaluating Rotator of graft cells by host cells occurred in the early remodeling process. Cuff Tear on MRI Infiltrated host cells to both the bursal and articular side play an im- Matsuura Koumei, Ishitani Eiichi, Department of Orthopaedic Sur- portant role in the early remodeling process after tendon implanta- gery, Kitakyushu Municipal Wakamatsu Hospital tion for a defect of the rotator cuff. The optimal position of the humerus when evaluating rotator cuff tears on MRI has yet to be determined. Obtaining a reproducible MR view without individual differences is important but it is sometimes difficult because the inclination of the scapulars are different. We de- 009 The Usefulness of Helical Computed Tomography with fined the ideal position of the humerus during MRI as follows: 1. Arthrography for the Evaluation of the Delamination of the Supraspinatus muscle runs straight and is parallel to the scapular Rotator Cuff Tear plane. The center of the insertion of the supraspinatus tendon was Fujii Yasunari, The Health Service Center, National Institute of Fit- nearly at the border between the superior and inferior facets (S/M ness and Sports in Kanoya border). We rotated the humerus so that the scapular plane was par- Togo Yasuhisa, Fukushima Kaori, Kakoi Hironori, Ogura Tadashi, allel to the S/M line. The S/M angle was defined as the angle be- Koshinkai Ogura Memorial Hospital tween two lines drawn from the center of the humeral head to S/ The purpose of this study was to show the usefulness of the recon- M border and to the bicipital groove. We defined q a the angle be- structed coronal and sagittal views after an arthrographic helical tween the scapular plane and the horizontal plane, and b as the an- computed tomography (HCTA) to perform the minute evaluation of gle made by the line drawn from the center to the bicipital groove the delamination of the rotator cuff tear (RCT).