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Patterns of tendon retraction in full-thickness rotator cuff tear: comparison of delaminated and nondelaminated tendons

  • Guillaume Bierry
  • William E. Palmer
Scientific Article

Abstract

Objective

To analyze full-thickness rotator cuff tears, compare retraction patterns in delaminated and nondelaminated tendons, and correlate retraction distances with anteroposterior tear lengths.

Materials and methods

In 483 MR examinations reported as showing full-thickness cuff tear, two musculoskeletal radiologists independently characterized tendons as delaminated or nondelaminated. Tendon delamination was defined as either horizontal intra-substance splitting of bursal and articular layers by an intervening plane of fluid, or differential retraction of bursal and articular layers. In a subset of 144 shoulders with surgically proven full-thickness cuff tears (45 delaminated, 99 nondelaminated tendons), matched cohorts (n = 45) were further analyzed to compare tendon retraction distance, anteroposterior tear length and retraction ratios (retraction distance/anteroposterior length).

Results

Delamination was present in 13% of 483 total tears, and 31% of 144 operated tears (p = 0.001). In nondelamination and delamination cohorts, mean anteroposterior tear length measured 30.0 and 31.5 mm respectively (p = 0.6). Although nondelaminated tendons showed mean retraction 31.5 mm, articular and bursal layers of delaminated tendons showed mean retractions 36.3 mm and 21 mm respectively (p < 0.0001). Anteroposterior tear length and retraction distance were significantly associated in all cuff tears (p < 0.0001). Retraction ratio for nondelaminated tendons (1.05) was significantly different from retraction ratios for articular (1.21) and bursal (0.70) layers of delaminated tendons (p < 0.0001).

Conclusion

In full-thickness rotator cuff tear, delaminated and nondelaminated tendons show significant differences in retraction distances, despite similarities in anteroposterior dimensions. Delaminated tendons are important to identify and report because they are more likely to fail conservative treatments and undergo operative repairs.

Keywords

Shoulder Rotator cuff tear Tendon delamination MRI 

Notes

Acknowledgements

We acknowledge the expert statistical assistance provided by Elkan F. Halpern, PhD.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© ISS 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity Hospital of StrasbourgStrasbourgFrance
  2. 2.Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

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