Nonlinear stress analysis of the supraspinatus tendon using three‐dimensional finite element analysis

PURPOSE: No studies have used stress analysis with finite element analysis (FEA) to determine the causes of and mechanisms underlying rotator cuff tears. Therefore, we performed a biomechanical evaluation of the changes in stress distribution on the rotator cuff using three-dimensional (3-D) FEA. METHODS: The 3-D FEA model of shoulder joint allowed for abduction angles of 0°, 45° and 90° from the plane of the scapula and included the anatomical insertion points of the three major rotator cuff tendons and the middle fibres of the deltoid muscle. Stress distribution of the supraspinatus tendon on 3-D FEA was validated by a comparison with cadaveric and two-dimensional finite element model. RESULTS: The principal stress peaked in the region approximately 1 cm proximal to the insertion of the supraspinatus tendon. Furthermore, the stress on the joint side increased at the anterior edge of the supraspinatus tendon at abduction angles of 45° and 90°. CONCLUSION: There are differences in stress changes between the joint side and bursal side of the supraspinatus tendon within the angles of abduction. The maximal tensile stress was observed on the articular side of the anterior edge of the supraspinatus tendon at 90° abduction. Our results indicate that the difference in tensile stress between the two layers results in delamination and causes partial-thickness tears. LEVEL OF EVIDENCE: Decision analysis, Level II.