Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Similar Degree of Degeneration in the Articular and Bursal Layers of Delaminated Rotator Cuff Tear

  • Jo, Chris Hyunchul (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Lee, Seung Hoo (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Shin, Ji Sun (Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine) ;
  • Kim, Ji Eun (Department of Pathology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine)
  • Received : 2016.01.14
  • Accepted : 2016.05.30
  • Published : 2016.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The purpose of the study was to compare the degree of degeneration of the articular and bursal layers of delaminated supraspinatus tendons based on histological examination. Methods: Fifty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from the lateral torn edges of the articular and bursal layers of the delaminated tear. Harvested samples were stained with H&E dye and evaluated based on a semi-quantitative grading scale. Results: There were no significant differences in the seven histological characteristics of tendon degeneration: fiber structure, fiber arrangement, round nuclei, regional variations in cellularity, vascularity, collagen stainability, and hyalinization between the articular and bursal layers of the delaminated rotator cuff tear (all p>0.05). Total degeneration scores of articular and bursal sides were $13.1{\pm}3.85$ points and $13.2{\pm}3.42$ points, respectively, and were not significantly different (p=0.958). Conclusions: The study demonstrates that tendon degeneration was similar in the articular and bursal sides of the delaminated full-thickness rotator cuff tear, suggesting that degeneration would be a main etiology for the rotator cuff tear not only in the articular side but also in the bursal side. Considering potential disadvantages of subacromial decompression, this study tentatively suggests routine use of subacromial decompression as well as the need for halting or recovery from rotator cuff degeneration for better rotator cuff repair.

Keywords

References

  1. Hermans J, Luime JJ, Meuffels DE, Reijman M, Simel DL, Bierma- Zeinstra SM. Does this patient with shoulder pain have rotator cuff disease?: the rational clinical examination systematic review. JAMA. 2013;310(8):837-47. https://doi.org/10.1001/jama.2013.276187
  2. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res. 2007;455:52-63. https://doi.org/10.1097/BLO.0b013e31802fc175
  3. Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am. 2012;94(3):227-33. https://doi.org/10.2106/JBJS.J.00739
  4. Via AG, De Cupis M, Spoliti M, Oliva F. Clinical and biological aspects of rotator cuff tears. Muscles Ligaments Tendons J. 2013;3(2):70-9.
  5. Kannus P, Jozsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. 1991;73(10):1507-25. https://doi.org/10.2106/00004623-199173100-00009
  6. Jo CH, Chang MS. Degeneration exists along the entire length of the supraspinatus tendon in patients with a rotator cuff tear. Clin Shoulder Elbow. 2015;18(2):61-7. https://doi.org/10.5397/cise.2015.18.2.61
  7. Nirschl RP. Rotator cuff tendinitis: basic concepts of pathoetiology. Instr Course Lect. 1989;38:439-45.
  8. Hashimoto T, Nobuhara K, Hamada T. Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res. 2003;(415):111-20.
  9. Flurin PH, Landreau P, Gregory T, et al. Arthroscopic repair of full-thickness cuff tears: a multicentric retrospective study of 576 cases with anatomical assessment. Rev Chir Orthop Reparatrice Appar Mot. 2005;91(S8):31-42.
  10. Sonnabend DH, Watson EM. Structural factors affecting the outcome of rotator cuff repair. J Shoulder Elbow Surg. 2002; 11(3):212-8. https://doi.org/10.1067/mse.2002.122272
  11. MacDougal GA, Todhunter CR. Delamination tearing of the rotator cuff: prospective analysis of the influence of delamination tearing on the outcome of arthroscopically assisted mini open rotator cuff repair. J Shoulder Elbow Surg. 2010;19(7): 1063-9. https://doi.org/10.1016/j.jse.2009.12.020
  12. Matsuki K, Murata R, Ochiai N, et al. Histological assessemnt of delamination observed in rotator cuff tears. Shoulder Joint (Katakansetsu). 2006;30(3):461-4.
  13. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74(5):713-25. https://doi.org/10.2106/00004623-199274050-00010
  14. Nakajima T, Rokuuma N, Hamada K, Tomatsu T, Fukuda H. Histologic and biomechanical characteristics of the supraspinatus tendon: reference to rotator cuff tearing. J Shoulder Elbow Surg. 1994;3(2):79-87. https://doi.org/10.1016/S1058-2746(09)80114-6
  15. Gwak HC, Kim CW, Kim JH, Choo HJ, Sagong SY, Shin J. Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2015;24(5):719-26. https://doi.org/10.1016/j.jse.2014.09.027
  16. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229-40.
  17. Movin T, Gad A, Reinholt FP, Rolf C. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthopaedica Scand. 1997;68(2):170-5. https://doi.org/10.3109/17453679709004002
  18. Astrom M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995;(316):151-64.
  19. Jo CH, Yoon KS, Lee JH, et al. The effect of multiple channeling on the structural integrity of repaired rotator cuff. Knee Surg Sports Traumatol Arthrosc. 2011;19(12):2098-107. https://doi.org/10.1007/s00167-011-1520-2
  20. Ko JY, Huang CC, Chen WJ, Chen CE, Chen SH, Wang CJ. Pathogenesis of partial tear of the rotator cuff: a clinical and pathologic study. J Shoulder Elbow Surg. 2006;15(3):271-8. https://doi.org/10.1016/j.jse.2005.10.013
  21. Fukuda H. The management of partial-thickness tears of the rotator cuff. J Bone Joint Surg Br. 2003;85(1):3-11. https://doi.org/10.2106/00004623-200300003-00002
  22. Chahal J, Van Thiel GS, Mall N, et al. The role of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis. Arthroscopy. 2012;28(11):1718-27. https://doi.org/10.1016/j.arthro.2012.03.007
  23. Goldberg BA, Nowinski RJ, Matsen FA 3rd. Outcome of nonoperative management of full-thickness rotator cuff tears. Clin Orthop Relat Res. 2001;(382):99-107.