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Irreparable rotator cuff tears: a novel classification system

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Abstract

Background

Irreparable rotator cuff tears can be managed by several approaches. However, current tear classifications fail to reflect the wide variety of their presentation, which has important clinical and prognostic implications.

Methods

We describe a novel classification system based on preoperative imaging findings and intraoperative observation where each cuff tendon (numbered sequentially: 1-supraspinatus, 2-infraspinatus, 3-teres minor, and 4-subscapularis) is assessed intraoperatively for reducibility to the footprint; tendons with reparable lesions are assessed for fatty degeneration (which predicts healing potential) and given a plus if degeneration is <50 % (Fuchs stage I–II/Goutallier stage 0–II) or a minus if it is ≥50 % (Fuchs stage III/Goutallier stage III–IV).

Results

The proposed system (1) allows more consistent and reproducible classification of cuff tears where at least one tendon is irreparable; (2) results in more accurate diagnosis; (3) guides in treatment selection; and (4) ensures better outcomes and realistic patient expectations.

Conclusions

The novel classification system can contribute to develop increasingly exhaustive and reproducible classification models.

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References

  1. Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr (1995) Débridement of degenerative irreparable lesions of the rotator cuff. J Bone Jt Surg Am 77:857–866

    Google Scholar 

  2. Cofield RH (1985) Rotator cuff disease of the shoulder. J Bone Jt Surg Am 67(974–9):3

    Google Scholar 

  3. Warner JJ (2001) Management of massive irreparable rotator cuff tears:the role of tendon transfer. Instr Course Lect 50:63–71

    CAS  PubMed  Google Scholar 

  4. Nakagaki K et al (1996) Fatty degeneration in the supraspinatus muscle after rotator cuff tear. J Shoulder Elb Surg 5(3):194–200

    Article  CAS  Google Scholar 

  5. Goutallier D, Patte D (1990) Assessment of the trophicity of the muscles of the ruptured rotator cuff by CT scan. In: Post MB, Hawkins RJ (eds) Surgery of the shoulder. Mosby, St Louis, pp 11–13

    Google Scholar 

  6. Kang JR, Gupta R (2012) Mechanisms of fatty degeneration in massive rotator cuff tears. J Shoulder Elb Surg 21(2):175–180. doi:10.1016/j.jse.2011.11.017

    Article  Google Scholar 

  7. Kuzel BR, Grindel S, Papandrea R, Ziegler D (2013) Fatty infiltration and rotator cuff atrophy. J Am Acad Orthop Surg 21(10):613–623. doi:10.5435/JAAOS-21-10-613

    Article  PubMed  Google Scholar 

  8. Gladstone JN, Bishop JY, Lo IK, Flatow EL (2007) Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35(5):719–728

    Article  PubMed  Google Scholar 

  9. Warner JJ (2001) Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect 50:63–71

    CAS  PubMed  Google Scholar 

  10. Dines DM, Moynihan DP, Dines J, McCann P (2006) Irreparable rotator cuff tears: what to do and when to do it; the surgeon’s dilemma. J Bone Jt Surg Am 88:2294–2302

    Article  Google Scholar 

  11. Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res 254:92–6

    Google Scholar 

  12. Werner CM, Conrad SJ, Meyer DC, Keller A, Hodler J, Gerber C (2008) Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements. J Shoulder Elb Surg 17:237–240

    Article  Google Scholar 

  13. Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86

    PubMed  Google Scholar 

  14. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    PubMed  Google Scholar 

  15. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full thickness tears. J Shoulder Elb Surg 12(6):550–554

    Article  Google Scholar 

  16. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 8(6):599–605

    Article  CAS  Google Scholar 

  17. Dwyer T, Razmjou H, Henry P, Gosselin-Fournier S, Holtby R (2013) Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2745-z

  18. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly: assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268

    Article  CAS  PubMed  Google Scholar 

  19. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Jt Surg Am 87(6):1229–1240

    Article  Google Scholar 

  20. Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N, Denaro V (2007) Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med 35(8):1254–1260

    Article  PubMed  Google Scholar 

  21. Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears outcome and analysis of factors associated with healing e failure or poor postoperative function. Am J Sports Med 41:1674

    Article  PubMed  Google Scholar 

  22. Chillemi C, Petrozza V, Garro L, Sardella B, Diotallevi R, Ferrara A, Gigante A, Di Cristofano C, Castagna A, Della Rocca C (2011) Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc 19(9):1588–1596. doi:10.1007/s00167-011-1521-1

    Article  CAS  PubMed  Google Scholar 

  23. Davidson PA, Rivenburgh DW (2009) Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elb Surg 9(6):502–506

    Article  Google Scholar 

  24. Porcellini G, Castagna A, Cesari E, Merolla G, Pellegrini A, Paladini P (2011) Partial repair of irreparable supraspinatus tendon tears: clinical and radiographic evaluations at long-term follow-up. J Shoulder Elb Surg 20:1170–1177

    Article  Google Scholar 

  25. Nho SJ, Delos DD, Yadav H et al (2010) Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears. Am J Sports Med 38(3):619–629

    Article  PubMed  Google Scholar 

  26. Nove-Josserand L, Costa P, Liotard JP, Safar JF, Walch G, Zilber S (2009) Results of latissimus dorsi transfer for irreparable cuff tears. Orthop Traumatol Surg Res 95(2):108–113

    Article  CAS  PubMed  Google Scholar 

  27. Gervasi E, Causero A, Parodi PC, Raimondo D, Tancredi G (2007) Arthroscopic latissimus dorsi transfer. Arthroscopy 23(11):1234e1–1234e4

    Article  Google Scholar 

  28. Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ (2008) Arthroscopic replacement of massive, irreparable rotator cuff tears using a Graft-Jacket allograft: technique and preliminary results. Arthroscopy 24(4):403–409

    Article  PubMed  Google Scholar 

  29. Pill SG, Walch G, Hawkins RJ, Kissenberth MJ (2012) The role of the biceps tendon in massive rotator cuff tears. Instr Course Lect 61:113–120

    PubMed  Google Scholar 

  30. Curtis AS, Burbank KM, Tierney JJ, Scheller AD, Curran AR (2006) The insertional footprint of the rotator cuff: an anatomic study. Arthrosc J Arthrosc Relat Surg 22(6):603–609

    Article  Google Scholar 

  31. Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Jt Surg Am 82:505–515

    CAS  Google Scholar 

  32. Neri BR, Chan KW, Kwon YW (2009) Management of massive and irreparable rotator cuff tears. J Shoulder Elb Surg 18:808–818

    Article  Google Scholar 

  33. Yoo JC, Ahn JH, Koh KH, Lim KS (2009) Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage. Arthroscopy 25:1093–1100

    Article  PubMed  Google Scholar 

  34. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Jt Surg Am 86:219–224

    Google Scholar 

  35. Collin P, Lädermann A, Le Bourg M, Walch G (2013) Subscapularis minor: an analogue of the Teres minor? Orthop Traumatol Surg Res 99(4 Suppl):S255–S258. doi:10.1016/j.otsr.2013.03.003

    Article  CAS  PubMed  Google Scholar 

  36. Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK (2013) Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Jt Surg Am 95(21):1920–1926

    Article  Google Scholar 

  37. Davidson J, Burkhart SS (2010) The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy 26(3):417–424

    Article  PubMed  Google Scholar 

  38. Lafosse L, Van Isacker T, Wilson JB, Shi LL (2012) A concise and comprehensive description of shoulder pathology and procedures: the 4d code system. Adv Orthop 2012:930543

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to Dr. S. Modena for the language revision (www.silviamodena.com).

Conflict of interest

Roberto Castricini, Massimo De Benedetto, Nicola Orlando, Enrico Gervasi, Alessandro Castagna declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Casa di Cura Villa Verde, Fermo, Italy

    R. Castricini, M. De Benedetto & N. Orlando

  2. Department of Orthopaedic and Trauma Surgery, Ospedale Civile, Latisana, Italy

    E. Gervasi

  3. Unit of Shoulder Surgery, Istituto Clinico Humanitas, Rozzano, Italy

    A. Castagna

Authors
  1. R. Castricini
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  2. M. De Benedetto
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  3. N. Orlando
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  4. E. Gervasi
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  5. A. Castagna
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Corresponding author

Correspondence to R. Castricini.

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Castricini, R., De Benedetto, M., Orlando, N. et al. Irreparable rotator cuff tears: a novel classification system. Musculoskelet Surg 98 (Suppl 1), 49–53 (2014). https://doi.org/10.1007/s12306-014-0320-5

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  • DOI: https://doi.org/10.1007/s12306-014-0320-5

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