Bursal-sided Tears Research Articles

Les ruptures partielles de la coiffe des rotateurs. Signification pathogénique et stratégie médico-chirurgicale actuelle

Partial-thickness rotator cuff tears comprise a partial interruption of the continuity of the tendon, with no relation to glenohumeral joint and subacromial bursa, as opposed to complete tears or the rotator cuff, and essentially affect the supraspinatus tendon. These might be in the form of bursal side tears, articular side tears or intrasubstance tears. Partial bursal side tears are explained by an impingement syndrome. Partial articular side tears are explained by a degeneration of the tendon and may be favoured by a trauma in patients over 40. In younger patients, partial bursal side tears may be due to an anterior instability, a posterior-superior glenoid impingement or to a trauma. The frequency of partial intrasubstance tears is probably underestimated because of the difficulties of diagnosis, now improved by magnetic resonance imaging. The therapeutic strategy depends on the age of the patient, the anatomic type and the extent of the lesion.

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

ObjectiveTo assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings.Materials and MethodsThe series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articular-sided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the inter- and intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears.ResultsThe sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal-sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate.ConclusionMR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and both articular- and bursal-sided tears. In addition, it shows only fair inter-observer agreement when it comes to predicting both articular- and bursal-sided tears.

Mattress suture-bridge technique for bursal-side partial-thickness rotator cuff tears

The standard procedure used to repair partial-thickness tears involves initial progression of the lesion to a full-thickness tear prior to tendon repair. However, the option for a bursal-side partial-thickness rotator cuff tear includes the preservation of as much of the remaining intact fibers as possible. Instead of inserting suture anchors in the medial row, as in the conventional suture-bridge technique, two mattress sutures are inserted into the rotator cuff. Full-thickness access is achieved using a percutaneous spinal needle and medial mattress sutures to preserve the articular bone attachment of the remnant fibers and to compress the repaired tendon on the footprint. Our method can help preserve the remnant rotator cuff tendon without tissue damage and can restore the normal rotator cuff footprint.

회전근 개 부분 파열에서 자기공명 관절조영술과 관절경 소견의 비교 연구

Purpose: The purpose of this study was to assess the efficacy of MR arthrography to detect partial thickness rotator cuff tears. Materials and Methods: One hundred and seventy seven patients with a high suspicion for rotator cuff disease were studied by performing MR-arthrography and subsequent arthroscopy. The ability of MR-arthrography to detect partial thickness tears was evaluated according to the location of the tears. We determined the correspondence between the measurements of the articular side partial tears on MR arthrography and those on the arthroscopic findings. Results: The arthroscopic diagnosis of partial thickness rotator cuff tears was divided into 3 groups according to their location. There were 63 cases on the articular side, 41 cases on the bursal side and 20 cases on both sides. The sensitivity of MR-arthrography was 82% for the articular side tears and 11% for the bursal tears. The specificity was 88% for the articular side tears and 100% for the bursal tears. MR-arthrographic measurement correctly predicted 72% in 28 repaired cases of 56 articular side partial thickness tears. Conclusions: MR-arthrography may be a reliable tool for diagnosing articular side partial thickness rotator cuff tears, but it has limitations for bursal side tears.

Clinical Features and Arthroscopic Findings of Partial Thickness Rotator Cuff Tears

Pur p ose: To compare the clinical features of partial thickness rotator cuff tears according to location of the tear and to classify the partial thickness rotator cuff tears based on arthroscopic findings. Mat e r ia ls and Met h ods: This study evaluated 138 patients who were arthroscpically proven to be partial thickness rotator cuff tears. Three groups were identified; 56 in the articular side tear, 58 in the bursal side tear, 24 in the both sides tear. The comparison included preoperative clinical features such as pain, range of motion and impingement sign. T he partial thickness rotator cuff tears were classified according to the arthroscopic findings.

The “paraglider-wing” sign: an arthroscopic indicator of partial-thickness bursal-surface tears of the supraspinatus tendon

Partial-thickness bursal-surface tears of supraspinatus tendon may be missed on preoperative investigations and can be overlooked at surgery if not specifically sought. The authors describe an arthroscopic sign to detect these tears, when they involve more than half the tendon fibres, from the articular-side of the joint. The "paraglider-wing" sign, visualized during diagnostic glenohumeral arthroscopy, is demonstrated as an upward bulge of the capsulo-tendinous layer through the bursal-surface tear, under pressure of the inflow fluid. A positive sign indicates (1) presence of a partial-thickness bursal-side tear of the supraspinatus tendon, (2) significant depth (stage II or III) of the tear, and (3) the medial extent of the tear along the length of the tendon. A meticulous subacromial bursoscopy and excision of the bursa is then performed to visualize the tear from the subacromial space. Repair of the tear is performed with a double-row suture anchor fixation technique; the medial row of sutures is passed through the intact region of the tendon using the "paraglider-wing" sign as a guide.

Pathogenesis of partial tear of the rotator cuff: A clinical and pathologic study

This prospective study investigated the clinical and pathologic results in 66 patients with partial tears of the rotator cuff from January 1996 to December 1998. The pathologic change in the rotator cuff was graded from the magnetic resonance images by using the criteria described by Zlatkin and Iannotti. A modified grading system from Ozaki and Panni was used for pathologic grading of the anterior acromion. The functional score of Constant and Murley was used for clinical assessment. The pathologic change in the rotator cuff revealed by the magnetic resonance imaging study was more severe in patients with articular side tears compared with patients who had bursal side tears. On the contrary, the pathologic changes in the acromion were significantly milder in patients with articular side tears compared with bursal side tears. These observations indicate that articular side tears of the rotator cuff are mainly associated with intrinsic pathologic changes of the rotator cuff, whereas bursal side tears are associated with subacromial impingement on an underlying milder pathologic change of the rotator cuff.

Acromial spur: Relationship to aging and morphologic changes in the rotator cuff

This study's objective is to elucidate the relationship between acromial spur formation and rotator cuff pathology or aging. The subjects comprised 1029 shoulders in control, cadaveric, and operative groups. A radiograph in the supraspinatus outlet view was taken in all subjects. The lengths of the incident spurs were measured and classified into 3 sizes (small, <5 mm; medium, <10 mm; and large, > or =10 mm). The rotator cuff was macroscopically classified as normal or as having bursal-side fraying, joint-side tear, intratendinous tear, bursal-side tear, complete tear limited to the supraspinatus tendon, or massive tear. In the control group, the overall incidence of spurs and spur size increased with advancing age (P < .001), but the majority of spurs were small (<5 mm). In the cadaveric group, the overall incidence did not correlate with advancing age (P > .05). However, spur size increased with age in subjects aged 50 years or older (P < .001). The incidence of spurs in rotator cuffs with bursal-side tears was highest and was significantly higher than that in normal cuffs and cuffs with bursal-side fraying and intratendinous tears. We observed 40% of medium spurs and 69% of large spurs in cases with bursal-side tears, complete tears limited to the supraspinatus tendon, and massive tears. In the operative group, the overall incidence correlated to advancing age (P < .001), reaching 80% or more in subjects aged 30 years or older. In addition, the size of spurs was larger than that in the other 2 groups in all age groups with few exceptions (P < .05). Small spurs were associated with advancing age. Morphologic change to the bursal side of the rotator cuff may enhance spur growth. The presence of a small spur has no diagnostic value for rotator cuff tears. Spurs measuring 5 mm or more, however, are of diagnostic value because of their high rate of association with bursal-side tear, complete tears limited to the supraspinatus tendon, or massive tears.

The keeled acromion: An aggressive acromial variant—a series of 20 patients with associated rotator cuff tears

<h2>Abstract</h2> This study describes our experience with an unusual type of acromial spur. In the last 7 years, we have treated 20 patients with a previously undescribed "keeled" acromion. The keel refers to a central, longitudinal, downward sloping spur on the acromial undersurface. Patients with a keeled acromion are at significant risk of bursal-sided as well as full-thickness rotator cuff tears. All patients in this series had significant bursal-sided tears, and 12 of 20 patients (60%) had full-thickness rotator cuff tears associated with an acromial "keel." In addition, patients with a keeled acromion are younger (average age, 52.7 years) than would be expected for patients with rotator cuff disease. Often these patients are misdiagnosed, and effective treatment is delayed. Diagnosis of a keeled acromion relies on a high level of suspicion, as well as knowledge of clinical and radiographic signs consistent with an acromial keel. We discuss the clinical presentation, radiographic findings, associated rotator cuff pathology, as well as methods to avoid intraoperative technical errors when treating patients with an acromial keel. The goal is to raise awareness of this relatively uncommon but clinically important entity and to help guide the treating surgeon's therapeutic measures.

The keeled acromion: an aggressive acromial variant--a series of 20 patients with associated rotator cuff tears.

This study describes our experience with an unusual type of acromial spur. In the last 7 years, we have treated 20 patients with a previously undescribed "keeled" acromion. The keel refers to a central, longitudinal, downward sloping spur on the acromial undersurface. Patients with a keeled acromion are at significant risk of bursal-sided as well as full-thickness rotator cuff tears. All patients in this series had significant bursal-sided tears, and 12 of 20 patients (60%) had full-thickness rotator cuff tears associated with an acromial "keel." In addition, patients with a keeled acromion are younger (average age, 52.7 years) than would be expected for patients with rotator cuff disease. Often these patients are misdiagnosed, and effective treatment is delayed. Diagnosis of a keeled acromion relies on a high level of suspicion, as well as knowledge of clinical and radiographic signs consistent with an acromial keel. We discuss the clinical presentation, radiographic findings, associated rotator cuff pathology, as well as methods to avoid intraoperative technical errors when treating patients with an acromial keel. The goal is to raise awareness of this relatively uncommon but clinically important entity and to help guide the treating surgeon's therapeutic measures.

Outcome of arthroscopic repair of high-grade, bursal-sided, partial rotator cuff tears (SS-04)

The natural history of the high-grade, partial tear of the bursal surface of the rotator cuff is not clearly understood. Recent evidence suggests that arthroscopic subacromial decompression or debridement alone can lead to poor outcome and may allow further deterioration of the rotator cuff. These tears may be particularly well-suited for an arthroscopic repair because of the presumably lower fixation demands afforded by the intact portion of the rotator cuff. We sought to evaluate the outcome of patients who’ve undergone arthroscopic repairs of high-grade bursal-sided rotator cuff tears. Methods: Between January 2000 and December 2002, 27 patients who had an intact articular surface, but a high-grade bursal-sided tear (>7 mm of exposed tuberosity) were treated with a subacromial decompression and an arthroscopic rotator cuff repair. All patients had a single row repair with at least one suture anchor. No lesion was completed to a full-thickness tear. Outcomes were assessed by serial examination and the L’Insalata shoulder rating questionnaire. Results: Mean follow-up was 24.5 months. 24 of the 25 patients were satisfied. L’Insalata scores increased from 34.7 to 85.1 (P < .001). Analysis of variance showed significant increases in abduction postoperatively (P = .004). Internal and external rotations were not significantly altered. Conclusions: Arthroscopic repair of high-grade, bursal-sided rotator cuff tears offer a high degree of patient satisfaction and functional improvement with low surgical morbidity. These outcomes appear to be favorable to previous reports of arthroscopic decompression and/or debridement. The natural history of the high-grade, partial tear of the bursal surface of the rotator cuff is not clearly understood. Recent evidence suggests that arthroscopic subacromial decompression or debridement alone can lead to poor outcome and may allow further deterioration of the rotator cuff. These tears may be particularly well-suited for an arthroscopic repair because of the presumably lower fixation demands afforded by the intact portion of the rotator cuff. We sought to evaluate the outcome of patients who’ve undergone arthroscopic repairs of high-grade bursal-sided rotator cuff tears. Methods: Between January 2000 and December 2002, 27 patients who had an intact articular surface, but a high-grade bursal-sided tear (>7 mm of exposed tuberosity) were treated with a subacromial decompression and an arthroscopic rotator cuff repair. All patients had a single row repair with at least one suture anchor. No lesion was completed to a full-thickness tear. Outcomes were assessed by serial examination and the L’Insalata shoulder rating questionnaire. Results: Mean follow-up was 24.5 months. 24 of the 25 patients were satisfied. L’Insalata scores increased from 34.7 to 85.1 (P < .001). Analysis of variance showed significant increases in abduction postoperatively (P = .004). Internal and external rotations were not significantly altered. Conclusions: Arthroscopic repair of high-grade, bursal-sided rotator cuff tears offer a high degree of patient satisfaction and functional improvement with low surgical morbidity. These outcomes appear to be favorable to previous reports of arthroscopic decompression and/or debridement.

Results of surgical treatment for incomplete bursal-side tears of the rotator cuff

Results of surgical treatment for incomplete bursal-side tears of the rotator cuff

Arthroscopic Debridement and Acromioplasty Versus Mini-Open Repair in the Treatment of Significant Partial-Thickness Rotator Cuff Tears

Summary: Partial tears of the rotator cuff, especially of the articular side, have received attention only with the recent ability of magnetic resonance imaging (MRI) and arthroscopy to diagnose these lesions. Several early reports showed nearly 100% success in managing these lesions with arthroscopic debridement with or without acromioplasty. This series compares 32 patients with significant partial-thickness rotator cuff tears treated with debridement and acromioplasty versus 33 patients with mini-open repair. Follow-up was from 2 to 7 years. Preoperative MRI was not useful; when positive, preoperative arthrography was useful for articular side tears. Of the tears, 12% were bursal side tears and the remainder were articular side tears; all were at least 50% or more of the thickness of the tendon. A significant number of the arthroscopic group had fair results by UCLA score criteria. Three patients reruptured the remaining cuff later despite adequate acromioplasty. Healing of the partial tear was never observed at second-look arthroscopy. Although postoperative pain was significantly greater and recovery slower with open repair, no patient was reoperated on and rerupture of the repair did not occur. The outstanding results of prior studies of cuff debridement were not duplicated in this series of cuff debridements with long-term follow-up. Adequate acromioplasty alone does not prophylactically prevent rotator cuff tear progression. Recognition and repair of these significant partial tears may be advisable for the long-term function of the shoulder despite short-term improvement in morbidity with arthroscopic treatment.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 2 (March), 1999: pp 126–131

Pathology and Pathogenesis of the Intratendinous Tearing of the Rotator Cuff Viewed From En Bloc Histologic Sections

Histologic sections from 17 en bloc surgical specimens were studied to clarify the pathogenesis of intratendinous tears of the rotator cuff. The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. An intratendinous tear alone was present in two patients, and was associated with bursal side cuff tears in seven patients and joint side cuff tears in eight. There were 13 men and 4 women, whose average age was 49.8 years. Trauma was noted in all intratendinous tears and combined intratendinous and joint side cuff tears and in two of the seven patients who had intratendinous plus bursal side tears. All patients exhibited clinical evidence of subacromial impingement. Histologic sections were stained with azan and hematoxylin and eosin. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. The intratendinous tears was located in the midlayer of the tendon in 15 specimens and eccentrically in two, the axis of which were parallel to tendon fibers in all. The intratendinous tears continued to local disruptions of the enthesis in 11 cases. The inner surface of the tear appeared smooth in 16 specimens. Despite the presence of granulation tissue and vessel proliferation near the intratendinous tears, there was no evidence of closure of the defect in any specimen. Intratendinous tears develop between superficial and deep layers of the degenerated rotator cuff. Shear within the tendon appears to be responsible in pathogenesis. Concomitant subacromial bursitis is very common.

Partial thickness rotator cuff tears: Results of arthroscopic treatment

Thirty-one patients with arthroscopically documented partial thickness rotator cuff tears treated by arthroscopic debridement of the lesion were retrospectively reviewed. The patients had had symptoms for an average of 20.5 months prior to surgery. Twenty-two of these 31 shoulders also had bursoscopy, with 18 having arthroscopic subacromial decompression. The results were graded by both the UCLA Shoulder Rating Scale and Neer's criteria. Twenty-six (84%) of the patients had satisfactory results with the remaining 5 (16%) patients having unsatisfactory results. A classification system for the size and location of partial thickness rotator cuff tears is presented. The lesion size did not affect the result. Repeat arthroscopy in three patients demonstrated no further deterioration of their rotator cuff. The results with and without subacromial decompression were similar. The need for subacromial decompression is best determined by the arthroscopic finding of a bursal side tear.

Subacromial Impingement and Its Effect on Incomplete Bursal Side Tears of the Rotator Cuff of the Shoulder

Subacromial Impingement and Its Effect on Incomplete Bursal Side Tears of the Rotator Cuff of the Shoulder

The investigation of the vibrational spectrum, optical constants and ionicity of bond of CdGeAs 2 in crystal and amorphous phases by infrared reflection

This prospective study investigated the clinical and pathologic results in 66 patients with partial tears of the rotator cuff from January 1996 to December 1998. The pathologic change in the rotator cuff was graded from the magnetic resonance images by using the criteria described by Zlatkin and Iannotti. A modified grading system from Ozaki and Panni was used for pathologic grading of the anterior acromion. The functional score of Constant and Murley was used for clinical assessment. The pathologic change in the rotator cuff revealed by the magnetic resonance imaging study was more severe in patients with articular side tears compared with patients who had bursal side tears. On the contrary, the pathologic changes in the acromion were significantly milder in patients with articular side tears compared with bursal side tears. These observations indicate that articular side tears of the rotator cuff are mainly associated with intrinsic pathologic changes of the rotator cuff, whereas bursal side tears are associated with subacromial impingement on an underlying milder pathologic change of the rotator cuff.

Electromigration and thermomigration in gamma-uranium

This prospective study investigated the clinical and pathologic results in 66 patients with partial tears of the rotator cuff from January 1996 to December 1998. The pathologic change in the rotator cuff was graded from the magnetic resonance images by using the criteria described by Zlatkin and Iannotti. A modified grading system from Ozaki and Panni was used for pathologic grading of the anterior acromion. The functional score of Constant and Murley was used for clinical assessment. The pathologic change in the rotator cuff revealed by the magnetic resonance imaging study was more severe in patients with articular side tears compared with patients who had bursal side tears. On the contrary, the pathologic changes in the acromion were significantly milder in patients with articular side tears compared with bursal side tears. These observations indicate that articular side tears of the rotator cuff are mainly associated with intrinsic pathologic changes of the rotator cuff, whereas bursal side tears are associated with subacromial impingement on an underlying milder pathologic change of the rotator cuff.