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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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
