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A Radiographic Classification of Massive Rotator Cuff Tear Arthritis

  • Symposium: Reverse Total Shoulder Arthroplasty
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4.

Questions/purposes

We therefore determined (1) whether patient characteristics and MRI findings differed between the grades at initial examination and final followup; (2) which factors affected progression to a higher grade; (3) whether the retear rate of repaired tendons differed among the grades; and (4) whether the radiographic grades at final followup differed from those at initial examination among patients treated operatively.

Patients and Methods

We retrospectively reviewed 75 patients with massive rotator cuff tears. Thirty-four patients were treated nonoperatively and 41 operatively.

Results

Patients with Grade 3, 4, or 5 tears had a higher incidence of fatty muscle degeneration of the subscapularis muscle than patients with Grade 1 or 2 tears. In 26 patients with Grade 1 or 2 tears at initial examination, duration of followup was longer in patients who remained at Grade 1 or 2 than in those who progressed to Grade 3, 4, or 5 at final followup. The retear rate of repaired supraspinatus tendon was more frequent in Grade 2 than Grade 1 tears. In operated cases, radiographic grades at final followup did not develop to Grades 3 to 5.

Conclusions

We believe cuff repair should be performed before acromiohumeral interval narrowing. Our observations are consistent with the temporal concepts of massive cuff tear pathomechanics proposed by Burkhart and Hansen et al.

Level of Evidence

Level III, Therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Burkhart SS. Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res. 1992;284:144–152.

    PubMed  Google Scholar 

  2. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy. 1994;10:363–370.

    Article  PubMed  CAS  Google Scholar 

  3. Bush LF. The torn shoulder capsule. J Bone Joint Surg Am. 1975;57:256–259.

    PubMed  CAS  Google Scholar 

  4. Clare DJ, Wirth MA, Groh GI, Rockwood CA Jr. Shoulder arthrodesis. J Bone Joint Surg Am. 2001;83:593–600.

    Article  PubMed  Google Scholar 

  5. Codsi MJ, Hennigan S, Herzog R, Kella S, Kelley M, Leggin B, Williams GR, Iannotti JP. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Surgical technique. J Bone Joint Surg Am. 2007;89(Suppl 2):1–9.

    Article  PubMed  Google Scholar 

  6. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.

    PubMed  Google Scholar 

  7. Debeyre J, Patte D, Elmelik E. Repair of ruptures of the rotator cuff of the shoulder. J Bone Joint Surg Br. 1965;47:36–42.

    PubMed  CAS  Google Scholar 

  8. Drake GN, O’Connor DP, Edwards TB. Indications for reverse total shoulder arthroplasty in rotator cuff disease. Clin Orthop Relat Res. 2010;468:1526–1533.

    Article  PubMed  Google Scholar 

  9. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82:505–515.

    PubMed  CAS  Google Scholar 

  10. González-Díaz R, Rodríguez-Merchán EC, Gilbert MS. The role of shoulder fusion in the era of arthroplasty. Int Orthop. 1997;21:204–209.

    Article  PubMed  Google Scholar 

  11. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin M-C. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.

    PubMed  Google Scholar 

  12. Goutailler D, Postel JM, Lavau L, Bernageau J. Influence of supraspinatus and infraspinatus muscular fatty degeneration on the prognosis of rotator cuff surgical repair [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1999;85:668–676.

    Google Scholar 

  13. Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res. 1990;254:92–96.

    PubMed  Google Scholar 

  14. Hamada K, Fukuda H, Nakajima T, Mikasa M. Comparative studies of arthrographic and operative findings in rotator cuff tears [in Japanese]. Katakannsetsu. 1991;15:141–147.

    Google Scholar 

  15. Hansen ML, Otis JC, Johnson JS, Cordasco FA, Craig EV, Warren RF. Biomechanics of massive rotator cuff tears: implications for treatment. J Bone Joint Surg Am. 2008;90:316–325.

    Article  PubMed  Google Scholar 

  16. Iannotti JP, Ciccone J, Buss DD, Visotsky JL, Mascha E, Cotman K, Rawool NM. Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am. 2005;87:1305–1311.

    Article  PubMed  Google Scholar 

  17. Iannotti JP, Hennigan S, Herzog R, Kella S, Kelley M, Leggin B, Williams GR. Latissimus dorsi tendon transfer for irreparable posterosuperior rotator cuff tears. Factors affecting outcome. J Bone Joint Surg Am. 2006;88:342–348.

    Article  PubMed  Google Scholar 

  18. Neer CS 2nd, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am. 1983;65:1232–1244.

    PubMed  Google Scholar 

  19. Nich C, Mutschler C, Vandenbussche E, Augereau B. Long-term clinical and MRI results of open repair of the supraspinatus tendon. Clin Orthop Relat Res. 2009;467:2613–2622.

    Article  PubMed  Google Scholar 

  20. Nové-Josserand L, Costa P, Liotard J-P, Safar J-F, Walch G, Zilber S. Results of latissimus dorsi tendon transfer for irreparable cuff tears. Orthop Traumatol Surg Res. 2009;95:108–113.

    Article  PubMed  Google Scholar 

  21. Nové-Josserand L, Walch G, Adeleine P, Courpron P. Effect of age on the natural history of the shoulder: a clinical and radiologic study in the elderly [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2005;91:508–514.

    PubMed  Google Scholar 

  22. Patte D, Debeyre DP, Goutallier D. Rotator cuff repair by muscle advancement. In: Bayley I, Kessel L, eds. Shoulder Surgery. Berlin, Heidelberg, New York: Springer; 1982:49–50.

    Google Scholar 

  23. Petroff E, Mestdagh H, Maynou C, Delobelle JM. Arthroplasty with a mobile cup for shoulder arthrosis with irreparable rotator cuff rupture: preliminary results and cineradiographic study [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1999;85:245–256.

    PubMed  CAS  Google Scholar 

  24. von Eisenhart-Rothe R, Müller-Gerbl M, Wiedemann E, Englmeier KH, Graichen H. Functional malcentering of the humeral head and asymmetric long-term stress on the glenoid: potential reasons for glenoid loosening in total shoulder arthroplasty. J Shoulder Elbow Surg. 2008;17:695–702.

    Article  Google Scholar 

  25. Walch G, Edwards B, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14:238–246.

    Article  PubMed  Google Scholar 

  26. Yamane S, Suenaga N, Oizumi N, Yamaguchi H, Minami A. A shoulder hemiarthroplasty with a tendon muscle transfer for glenohumeral arthritis associated with severe rotator cuff deficiency [in Japanese]. Katakansetsu. 2008;32:465–468.

    Google Scholar 

  27. Yoo JC, Ahn JH, Yang JH, Koh KH, Choi SH, Yoon YC. Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy. 2009;25:573–582.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Professor Pascal Boileau for encouraging us to write this article. We also thank Dr Gilles Walch for fruitful e-mail discussions and for allowing us to use his roentgenograms. We dedicate this work to the memory of Emeritus Professor Hiroaki Fukuda.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Hakone National Hospital, 412 Kazamatsuri, Odawara, Kanagawa, 250-0032, Japan

    Kazutoshi Hamada MD, PhD

  2. Yamanaka Orthopaedic Clinic, Shikichi, Shizuoka, Shizuoka, Japan

    Kaoru Yamanaka MD, PhD

  3. Tokai University School of Medicine, Isehara, Kanagawa, Japan

    Yoshiyasu Uchiyama MD, PhD

  4. Shizuoka Red Cross Hospital, Shizuoka, Shizuoka, Japan

    Takahiko Mikasa MD

  5. Matsudo Orthopaedic Hospital, Matsudo, Chiba, Japan

    Motohiko Mikasa MD, PhD

Authors
  1. Kazutoshi Hamada MD, PhD
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  2. Kaoru Yamanaka MD, PhD
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  3. Yoshiyasu Uchiyama MD, PhD
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  4. Takahiko Mikasa MD
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  5. Motohiko Mikasa MD, PhD
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Corresponding author

Correspondence to Kazutoshi Hamada MD, PhD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of these cases, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Shizuoka Red Cross Hospital, Hakone National Hospital, Yamanaka Orthopaedic Clinic, and Tokai University Hospital.

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Hamada, K., Yamanaka, K., Uchiyama, Y. et al. A Radiographic Classification of Massive Rotator Cuff Tear Arthritis. Clin Orthop Relat Res 469, 2452–2460 (2011). https://doi.org/10.1007/s11999-011-1896-9

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  • DOI: https://doi.org/10.1007/s11999-011-1896-9

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