Abstract:
Trauma, corticosteroid therapy and metabolic diseases are well established aetiologies
of humeral head osteonecrosis; however, there is increasing evidence that arthroscopic
rotator cuff surgery may be another possible cause. One of the reasons
is that there may be inadvertent damage to the arterial blood supply to the humeral
head during surgical intervention. The blood supply to the humeral head displays large
amounts of variation with regard to origin, course and distribution. Therefore, to shed
light on the pathogenesis, the blood supply of the humeral head is reviewed together
with a summary of all reported cases of osteonecrosis of the humeral head that occurred
following rotator cuff repair. Inconsistencies with regard to terminologies used
and contradictions concerning arterial contributions from the anterior circumflex
humeral artery and the posterior circumflex humeral artery towards humeral head
supply are addressed. Moreover, variations in the course of the anterior circumflex
humeral artery and its branches are summarized. The vascular anatomy of the humeral
head is clinically relevant due to the close relationship of these blood vessels
with the surgical repair sites for rotator cuff surgery and biceps tenotomies or tenodesis
procedures. Potential sites of disruption of blood supply following arthroscopic
rotator cuff surgery are discussed. Detailed knowledge of the course of the arteries
supplying the humeral head may help to minimize the risk of vascular injury and subsequent
osteonecrosis. Given the great interindividual variations of vascular anatomy,
imaging procedures preceding arthroscopic rotator cuff surgery may be advisable.
