Clinics in Shoulder and Elbow

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

DOI QR Code

Comparison of Clinical and Anatomical Outcomes between Delaminated Rotator Cuff Tear and Single Layer Rotator Cuff Tear

  • Park, Jin-Woo (Department of Orthopedic Surgery, Kangwon National University School of Medicine) ;
  • Moon, Sung-Hoon (Department of Orthopedic Surgery, Kangwon National University School of Medicine) ;
  • Lee, Jun-Hee (Department of Orthopedic Surgery, Kangwon National University School of Medicine)
  • Received : 2018.09.09
  • Accepted : 2018.10.16
  • Published : 2018.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. Methods: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). Results: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be $15.46{\pm}3.60mm$ and $14.17{\pm}3.16mm$ (p=0.013), and muscle atrophy of SS (occupation ratio) was $60.54{\pm}13.15$ and $56.55{\pm}12.88$ (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. Conclusions: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

Keywords

GJGJB6_2018_v21n4_207_f0001.png 이미지

Fig. 1. Measurement of the remnant tendon length and evaluation of delamination was done on oblique coronal T2 weighted image in preoperative magnetic resonance imaging. (A) Remnant tendon length was measured from the midpoint of lateral edge of the torn tendon to the musculotendinous junction on the clearest image obtained of the ‘midportion of tendon’. (B) Delamination of tendon was evaluated on oblique coronal image (arrows).

GJGJB6_2018_v21n4_207_f0002.png 이미지

Fig. 2. Muscle atrophy of supraspinatus was measured using occupation ratio at ‘Y’ view on oblique sagittal image in preoperative magnetic resonance imaging.

GJGJB6_2018_v21n4_207_f0003.png 이미지

Fig. 3. Fatty degeneration were evaluated on axial and oblique sagittal images in the preoperative magnetic resonance imaging. (A) Supraspinatus. (B) Infraspinatus.

GJGJB6_2018_v21n4_207_f0004.png 이미지

Fig. 4. Intraoperatively, the tear shape was evaluated at the lateral portal of bursoscopy. (A) Single layer tear. (B) Delaminated tear.

GJGJB6_2018_v21n4_207_f0005.png 이미지

Fig. 5. Rotator cuff repair. (A) Suture bridge double row repair was done for single layer tears. (B, C) En-masse suture bridge double row repair was done in cases of delaminated tears.

GJGJB6_2018_v21n4_207_f0006.png 이미지

Fig. 6. Repair integrity was followed by ultrasonography. (A) Intact repair integrity. (B) Retear. (A) Arrows indicate intact articular and bursal layer of repaired tendon. (B) Arrow indicates discontinuity of tendon. Rt SS: supraspinatus, Lt SS: supraspinatus.

Table 1. Comparison of Retear Rate between Single Layer Tear and Delaminated Tear

GJGJB6_2018_v21n4_207_t0001.png 이미지

Table 2. Comparison of Factors between Two Groups

GJGJB6_2018_v21n4_207_t0002.png 이미지

Table 3. Comparison of Factors between Retear and Non-retear Groups

GJGJB6_2018_v21n4_207_t0003.png 이미지

Table 4. Clinical Outcomes at Final Follow-up between Single Layer Tear and Delaminated Tear

GJGJB6_2018_v21n4_207_t0004.png 이미지

References

  1. 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.
  2. 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.
  3. 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
  4. Sonnabend DH, Yu Y, Howlett CR, Harper GD, Walsh WR. Laminated tears of the human rotator cuff: a histologic and immunochemical study. J Shoulder Elbow Surg. 2001;10:109-15. https://doi.org/10.1067/mse.2001.112882
  5. Mochizuki T, Sugaya H, Uomizu M, et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical technique. J Bone Joint Surg Am. 2009;91 Suppl 2 Pt 1:1-7.
  6. Mori D, Funakoshi N, Yamashita F. Arthroscopic lamina-specific double-row fixation for large delaminated rotator cuff tears. Arthrosc Tech. 2014;3(6):e667-71. https://doi.org/10.1016/j.eats.2014.08.004
  7. Park JY, Lhee SH, Oh KS, Moon SG, Hwang JT. Clinical and ultrasonographic outcomes of arthroscopic suture bridge repair for massive rotator cuff tear. Arthroscopy. 2013;29(2):280-9. https://doi.org/10.1016/j.arthro.2012.09.008
  8. Kim YK, Moon SH, Cho SH. Treatment outcomes of singleversus double-row repair for larger than medium-sized rotator cuff tears: the effect of preoperative remnant tendon length. Am J Sports Med. 2013;41(10):2270-7. https://doi.org/10.1177/0363546513499000
  9. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F. Atrophy of the supraspinatus belly. assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand. 1996; 67(3):264-8. https://doi.org/10.3109/17453679608994685
  10. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12(6):550-4. https://doi.org/10.1016/S1058-2746(03)00211-8
  11. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am. 2007;89(5):953-60. https://doi.org/10.2106/JBJS.F.00512
  12. Kim SJ, Choi YR, Lee HH, Chun YM. Surgical results of delaminated rotator cuff repair using suture-bridge technique with all-layers or bursal layer-only repair. Am J Sports Med. 2016;44(2):468-73. https://doi.org/10.1177/0363546515615573
  13. 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
  14. Kim CW, Kim JH, Gwak HC, Park JH. The comparison of outcomes between delaminated and nondelaminated rotator cuff tear repair: is delamination a negative prognostic factor? J Shoulder Elbow Surg. 2017;26(2):216-24. https://doi.org/10.1016/j.jse.2016.09.015
  15. Khair MM, Lehman J, Tsouris N, Gulotta LV. A systematic review of preoperative fatty infiltration and rotator cuff outcomes. HSS J. 2016;12(2):170-6. https://doi.org/10.1007/s11420-015-9465-5
  16. Le BT, Wu XL, Lam PH, Murrell GA. Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med. 2014;42(5):1134-42. https://doi.org/10.1177/0363546514525336
  17. McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA 3rd. Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med. 2015;43(2):491-500. https://doi.org/10.1177/0363546514529644
  18. Kim YK, Jung KH, Kim JW, Kim US, Hwang DH. Factors affecting rotator cuff integrity after arthroscopic repair for mediumsized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg. 2018;27(6):1012-20. https://doi.org/10.1016/j.jse.2017.11.016
  19. Jeong HY, Kim HJ, Jeon YS, Rhee YG. Factors predictive of healing in large rotator cuff tears: is it possible to predict retear preoperatively? Am J Sports Med. 2018;46(7):1693-700. https://doi.org/10.1177/0363546518762386
  20. Tashjian RZ, Hung M, Burks RT, Greis PE. Influence of preoperative musculotendinous junction position on rotator cuff healing using single-row technique. Arthroscopy. 2013; 29(11):1748-54. https://doi.org/10.1016/j.arthro.2013.08.014

Cited by

  1. Ultrasound Findings Aid Decisions to Repair Partial Articular Supraspinatus Tendon Avulsion vol.39, pp.10, 2018, https://doi.org/10.1002/jum.15307
  2. Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear vol.9, pp.3, 2018, https://doi.org/10.1177/2325967121990423