Purpose
To investigate (1) tendon delamination according to different rotator cuff tear patterns
as well as (2) the association of tendon retraction and fatty muscle infiltration
with delamination of the rotator cuff. Furthermore, we aimed to establish the accuracy
of magnetic resonance imaging for the detection of rotator cuff delamination.
Methods
Magnetic resonance imaging scans of patients who underwent arthroscopic rotator cuff
repair from 2013 to 2015 were retrospectively compared to intraoperative findings.
Prevalences of tendon delamination, tendon retraction, and fatty muscle infiltration
were categorized according to different rotator cuff tear patterns. For comparability
of the amount of tendon retraction of delaminated and non-delaminated rotator cuff
tears, we introduced the global retraction index, a description individually assessing
tendon retraction in magnetic resonance imaging scans of all visible layers.
Results
Of 349 shoulders, tendon delamination was observed in 231 patients (66.2%). Of these,
rotator cuff delamination was most commonly seen in posterosuperior rotator cuff tears
(84.6%). Delaminated rotator cuff tears presented with a significantly higher global
retraction index (P < .001) as well as higher fatty muscle infiltration of the supraspinatus (P = .001) and infraspinatus (P = .001). Magnetic resonance imaging had only moderate accuracy (57.3%) to detect
rotator cuff delamination, with a positive predictive value of 100% (95% confidence
interval [CI] 95.6% to 100.0%) and a negative predictive value of 44.2% (95% CI 38.1%
to 50.4%).
Conclusions
Tendon delamination was most commonly observed in posterosuperior rotator cuff tears.
Delaminated rotator cuff tears showed a significantly greater tendon retraction as
well as a higher amount of fatty muscle infiltration of the supraspinatus and infraspinatus.
Magnetic resonance imaging has only moderate accuracy for detection of rotator cuff
delamination.
Level of Evidence
III, retrospective cohort study.
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References
- Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village.J Orthop. 2013; 10: 8-12
- A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.J Shoulder Elbow Surg. 2014; 23: 1913-1921
- Natural history of degenerative rotator cuff tears.Curr Rev Musculoskelet Med. 2018; 11: 77-85
- Natural history of fatty infiltration and atrophy of the supraspinatus muscle in rotator cuff tears.Clin Orthop Relat Res. 2010; 468: 1498-1505
- Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy.J Bone Joint Surg Am. 1992; 74: 713-725
- Histologic and biomechanical characteristics of the supraspinatus tendon: Reference to rotator cuff tearing.J Shoulder Elbow Surg. 1994; 3: 79-87
- The superior capsule of the shoulder joint complements the insertion of the rotator cuff.J Shoulder Elbow Surg. 2012; 21: 867-872
- Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study.Am J Sports Med. 2012; 40: 2248-2255
- Laminated tears of the human rotator cuff: A histologic and immunochemical study.J Shoulder Elbow Surg. 2001; 10: 109-115
- The knotless cinch-bridge technique for delaminated rotator cuff tears leads to a high healing rate and a more favorable short-term clinical outcome than suture-bridge repair.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3920-3928
- An arthroscopic knotless technique for anatomical restoration of the rotator cuff and superior capsule: The double-layer cinch bridge.Arthrosc Tech. 2018; 7: e7-e12
- Delaminated rotator cuff tears showed lower short-term retear rates after arthroscopic double-layer repair versus bursal layer-only repair: A randomized controlled trial.Am J Sports Med. 2020; 48: 689-696
- Conventional en masse repair versus separate double-layer double-row repair for the treatment of delaminated rotator cuff tears.Am J Sports Med. 2016; 44: 1146-1152
- Morphologic factors related to repair outcomes for delaminated rotator cuff tears: A minimum 2-year retrospective comparison study.Arthroscopy. 2019; 35: 332-340
- Comparison of en masse versus dual-layer suture bridge procedures for delaminated rotator cuff tears.Arthroscopy. 2018; 34: 3150-3156
- Arthroscopic double-layer lasso loop technique to repair delaminated rotator cuff tears.Arthroscopy. 2018; 34: 2943-2951
- Double-layer rotator cuff repair anatomic reconstruction of the superior capsule and rotator cuff improves biomechanical properties in repairs of delaminated rotator cuff tears.Am J Sports Med. 2019; 46: 3165-3173
- Retraction pattern of delaminated rotator cuff tears: Dual-layer rotator cuff repair.J Orthop Surg Res. 2016; 11: 75
- Delaminated rotator cuff tear: Extension of delamination and cuff integrity after arthroscopic rotator cuff repair.J Shoulder Elbow Surg. 2015; 24: 719-726
- Structural factors affecting the outcome of rotator cuff repair.J Shoulder Elbow Surg. 2002; 11: 212-218
- Is posterior delamination in arthroscopic rotator cuff repair hidden to the posterior viewing portal?.Arthroscopy. 2013; 29: 1740-1747
- The effect of tendon delamination on rotator cuff healing.Am J Sports Med. 2019; 47: 1074-1081
- Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal?.J Bone Joint Surg Am. 2005; 87-A: 1229-1240
- 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: 1063-1069
- Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: A prospective outcome study.J Bone Joint Surg Am. 2007; 89: 953-960
- Classification of rotator cuff lesions.Clin Orthop Relat Res. 1990; 254: 81-86
- Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging.J Shoulder Elbow Surg. 1999; 8: 599-605
- Fatty muscle degeneration in cuff ruptures: Pre- and postoperative evaluation by CT scan.Clin Orthop Relat Res. 1994; 304: 78-83
- Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.J Shoulder Elbow Surg. 2003; 12: 550-554
- Atrophy of the supraspinatus belly: Assessment by MRI in 55 patients with rotator cuff pathology.Acta Orthop Scand. 1996; 67: 264-268
- Answering the call for a standard reliability measure for coding data.Commun Methods Meas. 2007; 1: 77-89
- The rotator cuff and the superior capsule: Why we need both.Arthroscopy. 2016; 32: 2628-2637
- Role of the superior shoulder capsule in passive stability of the glenohumeral joint.J Shoulder Elbow Surg. 2014; 23: 642-648
- 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: 468-473
- Delaminated tears of the rotator cuff: Prevalence, characteristics, and diagnostic accuracy using indirect MR arthrography.AJR Am J Roentgenol. 2015; 204: 360-366
- Inter-rater agreement of the Goutallier, Patte, and Warner classification scores using preoperative magnetic resonance imaging in patients with rotator cuff tears.Arthroscopy. 2012; 28: 154-159
- Assessment of tendon retraction in large to massive rotator cuff tears: A modified Patte classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability.Arthroscopy. 2020; 36: 2822-2830
- Relationship of tear size and location to fatty degeneration of the rotator cuff.J Bone Joint Surg Am. 2010; 92: 829-839
- Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair.Am J Sports Med. 2012; 40: 2242-2247
- Patterns of tendon retraction in full-thickness rotator cuff tear: Comparison of delaminated and nondelaminated tendons.Skeletal Radiol. 2019; 48: 109-117
- MR imaging of delamination tears of the rotator cuff tendons.Skeletal Radiol. 2007; 36: 411-416
- Detecting rotator cuff tears: A network meta-analysis of 144 diagnostic studies.Orthop J Sports Med. 2020; 8 (2325967119900356)
Article Info
Publication History
Published online: December 27, 2021
Accepted:
December 16,
2021
Received:
August 7,
2021
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America
