Tensile strength of the supraspinatus after reimplantation into a bony trough: An experimental study in rabbits

The goals of this study were to determine the strength of the supraspinatus tendon after reimplantation into a bony trough and to find out whether the fibrocartilaginous enthesis reformed. In 21 rabbits, the suprospinatus tendon was transected and reinserted into a bony trough at the greater tuberosity. After sacrifice at 8 and 12 weeks, tensile strength was measured. Microscopically, the presence of fibrocartilage and the spatial orientation of the cartilage columns and collagen fibers were assessed. At sacrifice, 14 of 21 reinserted specimens had healed successfully and were studied. Most mechanical failures occurred through bone, and none failed at the site of reimplantation. The mean peak loads of the operated tendons were significantly lower than their controls (8 weeks, 134.8 +/- 49.9 N vs 223.1 +/- 33.4 N, and 12 weeks, 172.2 +/- 68.2 N vs 274.1 +/- 70.0; P = .013 and P = .025, respectively). Histologically, at 8 weeks, the fibrocartilaginous enthesis had partially reformed; it was narrower than normal, and the collagen fibers had only partially assumed their normal spatial arrangement. Twelve weeks after reimplantation, 4 of 7 entheses had a normal histologic appearance. We conclude that return of strength of the supraspinatus tendon is evident 8 weeks after surgical reattachment into a bony trough and that the fibrocartilaginous enthesis is normal in over half of the specimens at 12 weeks. The subchondral bone was weaker than the reinserted tendon. The results support the clinical practice of surgical reimplantation. Avoiding active exercises early while promoting them later could improve the surgical results and reduce the effects of disuse.