Rotator Cuff Tendon Research Articles

Understanding Fibrous Tissue in the Effective Healing of Rotator Cuff Injury.

The rotator cuff is a crucial group of muscles and tendons in the shoulder complex that plays a significant role in the stabilization of the glenohumeral joint and enabling a wide range of motion. Rotator cuff tendon tears can occur due to sudden injuries or degenerative processes that develop gradually over time, whether they are partial or full thickness. These injuries are common causes of shoulder pain and functional impairment, and their complex nature highlights the essential role of the rotator cuff in shoulder function. Scar formation is a crucial aspect of the healing process initiated following a rotator cuff tendon tear, but excessive fibrous tissue development can potentially lead to stiffness, discomfort, and movement limitations. Age is a critical risk factor, with the prevalence of these tears increasing among older individuals. This comprehensive review aims to delve deeper into the anatomy and injury mechanisms of the rotator cuff. Furthermore, it will inspect the signaling pathways involved in fibrous tissue development, evaluate the various factors affecting the healing environment, and discuss proactive measures aimed at reducing excessive fibrous tissue formation. Lastly, this review identifed gaps within existing knowledge to advance methods for better management of rotator cuff tendon injuries.

Early career accuracy of shoulder ultrasound in evaluating rotator cuff tendon tears

Early career accuracy of shoulder ultrasound in evaluating rotator cuff tendon tears

Associations between fatty infiltration of rotator cuff muscles and tear size or location of rotator cuff tendon.

Fatty infiltration (FI) of rotator cuff muscles in patients with rotator cuff tears is an important imaging factor for determining surgical indications. However, the associations between FI grade and the size or location of adjacent rotator cuff tears are not well-known. This study aimed to primarily determine whether tear size and location, especially for the SSc tendon, are associated with FI of adjacent rotator cuff muscles. The secondary aim was to clarify which patient factors are associated with rotator cuff muscle FI in rotator cuff tear cases. This study examined 373 shoulders of 348 patients (264 males and 109 females; mean age of 62.8 years) who underwent arthroscopic rotator cuff surgery. The FI grades of the supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSc) muscles were assessed using preoperative magnetic resonance imaging (MRI) using the Goutallier classification modified by Fuchs. According to the preoperative MRI and intraoperative findings, the tear size of the posterior-superior rotator cuff (SSP-ISP) was classified using a modified six-grade scale of the Cofield classification, and that of the SSc tear was classified using a six-grade scale according to the Lafosse classification. Age at surgery, sex, body mass index (BMI), presence of diabetes mellitus (DM) or hyperlipidemia (HL), trauma history, and duration of symptoms were investigated. The FI grades of the SSP, ISP, and SSc were significantly associated with the size of the tears in those muscles (all P < 0.01). Furthermore, the FI grades of the SSP and the ISP were significantly associated with SSc tear size (P < 0.01), and the FI grade of the SSc was significantly associated with SSP-ISP tear size (P < 0.01). Patient age at surgery was significantly associated with FI grade (P < 0.01), with significant progression of the FI grade with advancing age. However, there were no significant associations between the FI grade and sex, BMI, presence of DM or HL, trauma history, and duration of symptoms. The FI grade of each of the rotator cuff muscles is affected by not only the tear severity of the muscle concerned but also by the severity of any tear in the adjacent rotator cuff.

Chronic Adaptation of Achilles Tendon Tissues upon Injury to Rotator Cuff Tendon in Hyperlipidemic Swine

Chronic Adaptation of Achilles Tendon Tissues upon Injury to Rotator Cuff Tendon in Hyperlipidemic Swine

Arthroscopic Rotator Cuff Repair in the Elderly: Long-Term Outcomes

Abstract Introduction: Rotator cuff tear (RCT) is one of the most common ailments around the shoulder. Its incidence increases significantly with age. However, owing to the variable healing potential and retear rates, the ideal management of RCT in the elderly is still up for debate. The purpose of this study is to observe and analyze the long-term functional outcomes in patients older than 60 years of age, who have undergone arthroscopic RCT repair. Methods: Fifty-seven cases who had undergone arthroscopic RCT repair with a minimum postoperative follow-up for 3 years were identified, in this single surgeon monocentric retrospective study. They were assessed using shoulder pain and disability index (SPADI) scoring. Results: Out of the 57 patients with ages more than 60 years, 10 were beyond 70 years of age. The mean age of the group was 65.2 years (standard deviation [SD] =4.86) ranging from 60 to 84 years. The mechanism of injury was atraumatic in 27 cases. The mean follow-up period was 57.9 months (SD = 15.7). The cases were categorized based on the number of rotator cuff tendons involved in the tear. The mean SPADI% for pain in all the cases was 0.98% (SD = 2.1). Forty-two out of the total 57 cases had a SPADI of 0%. They were completely asymptomatic, with their operated shoulder as good as the other. No statistically significant correlation was found between the SPADI scores and the number of tendons repaired (r = 0.06). Conclusion: An optimal tension-free arthroscopic repair of the RCT can yield good results even in the elderly. The age of the patient, the duration of the tear before surgery, and the size of the tear should not be considered as a stand-alone factor to deny surgical management if the fatty infiltration is within a limit. Irrespective of the retear rates the overall functional outcomes are still good.

Influence of Critical Shoulder Angle and Rotator Cuff Tear Type on Load‐Induced Glenohumeral Biomechanics: A Sawbone Simulator Study

Glenohumeral (GH) biomechanics after rotator cuff (RC) tears are not fully understood. The purpose of our study was to determine if the critical shoulder angle (CSA), type of RC tears, and level of weight bearing increase GH translation, instability based on the instability ratio, muscle forces and joint reaction force (JRF), and shifts the center of force (CoF) superiorly. A GH simulator with muscle‐mimicking cable systems was used to simulate 30° abduction in the scapular plane. A Sawbone humerus and five specimen‐specific scapular anthropometries were used to test six types of RC tears, three weight‐bearing loads, and the native and adjusted (to different CSAs) deltoid origin sites. Linear mixed effects models (CSA, RC tear type, and weight bearing) with random effects (specimen and sex) were used to assess differences in GH biomechanics. With increasing CSA, GH translation increased, JRF decreased, and the CoF position was more inferior. RC tears did not significantly alter GH translation but shifted the CoF position superiorly, close to where glenoid erosion occurs in patients with RC tears with secondary osteoarthritis. Weight bearing significantly increased GH translation and JRF. RC and deltoid muscle forces increased with the presence of RC tears and increased weight bearing. The remaining RC muscles of intact tendons compensated for the torn RC tendons but not for the altered CoF position. GH translation remained comparable to shoulders with intact RC. These findings highlight the importance of early detection, clinical management, and targeted rehabilitation strategies for patients with RC tears.

Role of Ultrasound Guided Platelet Rich Plasma Therapy for Isolated Supraspinatus Tendinopathy

Background: Rotator cuff (RC) injuries are not so uncommon a cause of disability among the population. The RC stabilizes the shoulder, a highly unstable joint owing to great mobility. Supraspinatus (SS) is one of the RC tendons undergoing damage ranging from mild tendinosis to complete tear due to degeneration, trauma, or other causes. Supraspinatus tears (STs) have been classically treated conservatively with physical and pharmacotherapy and later on with the help of surgical repair. Non-surgical treatment with biologics like platelet-rich plasma (PRP) therapy has been tried with positive results but with limited data. We aim to identify the role of PRP therapy in patients with symptomatic supraspinatus tendinopathy (STP) for improving the range of motion as well as reducing the pain and physical disability.Methods: This study was done on fifty symptomatic STP patients who failed medical and physical therapy for at least three months. The improvement in the pain score following two sittings of PRP therapy was evaluated with numerical rating scale (NRS). The improvement of the function of shoulder joint movements for daily activities was assessed with the modified University of California-Los Angeles (UCLA) shoulder score. Moreover, NRS, tear size (TS, assessed with ultrasound), Constant Shoulder Score (CSS), and modified UCLA shoulder score were recorded at baseline, and subsequently at 1-month, 3-months, and 6-months following the second sitting of the PRP therapy.Results: At baseline, the CSS was 36.42±5.12, and was 61.58±6.35, 81.22±6.23, and 87±3.9 at 1-month, 3-months, and 6-months follow-up, respectively. The NRS was 8.18±0.96 before the procedure and 4.26±0.8, 2.02±0.62, 1.84±0.51 at 1-month, 3-months, and 6-months follow-up, respectively. The mean TS pre-procedure was 3.12±0.89, and a significant decrease in TS was seen at 1-month (2.87±0.88), 3-months (2.44±0.79), and 6-months (2.17±0.76). Modified UCLA score was 16.86±3.49 at baseline which improved to 24.66±3.17 at 1-month, 31.64±2.69 at 3-months, and 32.5±1.67 at 6-months.Conclusion: PRP results in healing of the torn SS tendon. It also reduces pain score, improve range of motion and quality of life of the patients.

Brief Commentary and Based on the Article Entitled “Ultrasound-Guided Electroacupuncture Treatment for Rotator Cuff Tendinopathy: Proposing an Effective Alternative to Non-Operative Medical Treatments”

Specifically, it utilizes ultrasound to see areas of injury/pathology within the rotator cuff tendon(s) and ultrasound to visualize acupuncture needle placement into these areas

A scoping review of tendon transfer surgeries and postsurgical physical therapy interventions in individuals with massive rotator cuff tears.

To identify tendon transfer surgeries and postsurgical physical therapy interventions in people with massive rotator cuff (RC) tears. The literature search was conducted in the MEDLINE, Science Direct, Scopus, Web of Science, and PEDro databases from inception to September 2022. Studies with patients diagnosed with massive RC tears undergoing tendon transfers that reported physical therapy interventions after surgery were included. Two reviewers pooled the data into ad hoc summary tables with the following information: authors, year, study characteristics (sample size, tendon transfer surgical used, approach type, preoperative risk, deficit addressed, additional surgical interventions), and physical therapy interventions (early stage, intermediate stage, and advanced stage). Forty-four articles (59.0% case series) were included, with a total sample of 1213 participants. The most frequently used surgery was the isolated tendon transfer of the latissimus dorsi (49.1%). Most of the studies reported three main stages of physical therapy interventions after tendon transfer surgery: early stage (lasting 5-6 weeks), intermediate stage (started at 7-12 weeks), and advanced stage (started at 12 weeks). Physical therapy interventions included passive, active-assisted, resisted therapeutic exercise, and hydrotherapy. The evidence regarding physical therapy interventions after RC tendon transfer surgery is limited to the number and duration of the stages and general characteristics without specifying the type and dose of the interventions. Future research with high methodological quality should integrate more detailed rehabilitation protocols to better guide therapeutic decisions after RC transfer surgery.

Arthroscopic assistance of latissimus dorsi tendon transposition for the treatment of unrepairable rotator cuff tear

To explore clinical effect of arthroscopy-assisted rotator cuff tendon transfer in treating irreparable rotator cuff tears (IRCT). From May 2015 to May 2018, 23 patients with unrepairable rotator cuff tears were treated with arthroscopy-assisted rotator cuff tendon transfer, and 21 patients were followed up finally, including 8 males and 13 females, aged from 48 to 82 years old with an average of(64.3±9.1) years old;the courses of disease ranged from 6 to 36 months with an average of (14.0±6.4) months. American Rotator and Elbow Surgeons Score(ASES) and Constant-Murley score were used to evaluate clinical efficacy before surgery and at the latest follow-up. All 21 patients were followed up for 36 to 54 months with an average of (39.4±4.4) months. Axillary incision of 1 patient was redness, swelling and exudation after surgery, which healed after 3 weeks of dressing change, and exudate culture was negative. At the latest follow-up, MRI showed partial tearing of the metastatic tendon in 2 patients, but pain and movement of the affected shoulder were still better than before surgery. ASES increased from preoperative (41.0±9.6) scores to the latest follow-up (75.6±14.0) scores, and had statistical difference (t=10.50, P<0.01). Constant-Murley score increased from (49.8±7.1) scores before operation to (67.5±11.6) scores at the latest follow-up (t=11.27, P<0.01). Arthroscopic assisted latissimus dorsalis tendon transposition restores physiological and anatomical structure of glenohumeral joint by reconstructing balance of horizontal and vertical couples of shoulder joint, thus achieving the stability of the shoulder joint, relieving shoulder pain and improving shoulder joint function.

Pro-Resolving Mediators in Rotator Cuff Disease: How Is the Bursa Involved?

So far, tendon regeneration has mainly been analyzed independent from its adjacent tissues. However, the subacromial bursa in particular appears to influence the local inflammatory milieu in the shoulder. The resolution of local inflammation in the shoulder tissues is essential for tendon regeneration, and specialized pro-resolving mediators (SPMs) play a key role in regulating the resolution of inflammation. Here, we aimed to understand the influence of the bursa on disease-associated processes in neighboring tendon healing. Bursa tissue and bursa-derived cells from patients with intact, moderate and severe rotator cuff disease were investigated for the presence of pro-resolving and inflammatory mediators, as well as their effect on tenocytes and sensitivity to mechanical loading by altering SPM signaling mediators in bursa cells. SPM signal mediators were present in the bursae and altered depending on the severity of rotator cuff disease. SPMs were particularly released from the bursal tissue of patients with rotator cuff disease, and the addition of bursa-released factors to IL-1β-challenged tenocytes improved tenocyte characteristics. In addition, mechanical loading modulated pro-resolving processes in bursa cells. In particular, pathological high loading (8% strain) increased the expression and secretion of SPM signaling mediators. Overall, this study confirms the importance of bursae in regulating inflammatory processes in adjacent rotator cuff tendons.

Associations of normal fasting glucose levels and of insulin resistance with degenerative rotator cuff tear

BackgroundThe upper normoglycemic range has been proposed as a risk factor for degenerative rotator cuff tendon tear (RCT), and insulin resistance has been suggested as a risk factor for tendinopathy. However, no research has established their association with degenerative RCT in the general population. This study aimed to determine whether fasting glucose levels and insulin resistance are risk factors for degenerative RCT in the normoglycemic population and identify the risk range for fasting glucose.MethodsThis study included 418 normoglycemic participants from a rural cohort. Participants completed questionnaires, physical exams, blood tests, and MRI evaluations of both shoulders. Insulin resistance was assessed using a triglyceride/high-density-lipoprotein (TG/HDL) ≥ 3.5. Logistic regression analysis was used to determine the association between fasting glucose level, TG/HDL ≥ 3.5, and other factors and degenerative RCT. The study calculated the areas under the receiver operating characteristic curve (AUC) to determine the more appropriate predicting value between the scale and categorical values of fasting glucose levels, and compared the AUCs using the DeLong method.ResultsIn the multivariable analyses, both scale and categorical values of fasting glucose levels, and TG/HDL ≥ 3.5 were significantly associated with degenerative RCT. Fasting glucose levels ≥ 90.5 mg/dL (OR: 3.87, 95% CI: 2.10–7.06) in scale value and 90–99 mg/dL (OR: 4.13, 95% CI: 2.87–8.12) in categorical value were significantly associated with degenerative RCT (P < .001). The AUC of the scale value of fasting glucose levels ≥ 90.5 mg/dL was 0.68. The AUC of the categorical value of fasting glucose levels of 90–99 mg/dL was 0.70. Because of the significantly larger AUC of the categorical value of fasting glucose levels of 90–99 mg/dL, those fasting glucose levels were determined to be independently associated with degenerative RCT (P < .001).ConclusionsHigh fasting glucose levels within the normal range may link to increase insulin resistance and risk of degenerative RCT. Normoglycemic levels of 90–99 mg/dL and insulin resistance may be risk factors for degenerative RCT.Level of evidenceLevel III, prognostic study.

Rotator cuff tendon ruptures (literature review)

Rotator cuff injury is a common pathology: up to 20 % of the population over 45 years of age has ruptures of varying severity, and up to 40 % of these ruptures are large and massive. The gradual development of tendon degeneration and fatty degeneration of muscle tissue and the asymptomatic course of the disease often lead to late medical attention when secondary arthropathy of the shoulder joint develops. With age, the probability of having a rupture increases, reaching 51 % in people over 80 years of age. The main diagnostic tools are radiography and magnetic resonance imaging of the shoulder joint combined with clinical examination. Conservative treatment for massive injuries is ineffective, and the risk of worsening rotator cuff tendinopathy to rupture reaches 54 %. There are three main directions in the surgery of rotator cuff injuries: tendon reconstruction or replacement of their defect with grafts; muscle transfer; shoulder arthroplasty. Subacromial balloon spacer and tenogenic patches are also used. Each of these methods has a number of disadvantages and limitations. The frequency of repeated ruptures of reconstructed tendons reaches 45 %. Muscle transfer is extremely demanding on the skill of the surgeon and is associated with high risks of neurological complications. Arthroplasty imposes a number of significant restrictions on the patient, reducing the quality of life, and prosthesis components wear increases the risk of complications, especially during revision interventions. The use of the subacromial spacer is limited by its high cost and lack of long-term follow-up of treatment outcomes. Tenogenic patches have not undergone clinical trials, being an experimental technique. There is no single approach to the treatment of massive rotator cuff ruptures. The results are contradictory, the advantages of each of the methods are balanced by their disadvantages, which provides a wide window of opportunity in the studying, optimizing classical and introducing new methods of treatment of this pathology

Middle trapezius tendon transfer using Achilles allograft for irreparable isolated supraspinatus tendon tears effectively restores the superior stability of the humeral head without restricting range of motion: a biomechanical study

BackgroundMiddle trapezius tendon (MTT) transfer has been suggested for promising treatment of irreparable isolated supraspinatus tendon tears (IISTTs). However, there have been no attempts to assess the biomechanical efficacy of MTT transfer. This study aims to evaluate the biomechanical efficacy of MTT transfer in the setting of IISTTs. MethodsEight fresh-frozen cadaveric shoulders were tested in three conditions (1) intact rotator cuff, (2) IISTTs, and (3) Middle trapezius tendon transfer (MTT) using Achilles allograft for IISTTs. Total humeral rotational range of motion, superior translation of the humeral head, and subacromial contact characteristics were measured at 0°, 20°, and 40° glenohumeral abduction (representing 0°, 30°, and 60° shoulder abduction). Superior translation and subacromial contact pressures were measured at 0°, 30°, 60° and 90° external rotation (ER). Two different MTT muscle loading conditions were investigated. A linear mixed-effects model and Tukey post hoc test were used for statistical analysis. ResultsTotal range of motion was significantly increased after IISTT at 20° abduction (P =.037). There were no changes in total ROM following MTT transfer compared to the IISTT condition (P>.625 for all comparisons). The IISTT condition significantly increased superior translation compared to the intact rotator cuff condition in 0° and 20° abduction with all ER angles (P<.001), 40° abduction/30° ER (P=.016), and 40° abduction/60° ER (P=.002). MTT transfer significantly decreased superior translation of the humeral head at all abduction angles compared to the IISTTs condition (P<.026). MTT transfer significantly decreased peak contact pressure by 638.7 kPa (normal loading) and 726.8 kPa (double loading) at 0° abduction/30° ER compared to the IISTTs condition (P<.001). Mean contact pressure was decreased by 102.8 kPa (normal loading) and 118.0 kPa (double loading) at 0° abduction/30° ER (P<.001) and 101.0 kPa (normal loading) and 99.2 kPa (double loading) at 0° abduction/60° ER (P<.001). MTT transfer at 20° abduction/30° ER with 24N loading significantly decreased contact pressure by 91.2 kPa (P=.035). ConclusionsThe MTT transfer biomechanically restored the superior humeral head translation and reduced the subacromial contact pressure in a cadaveric model of IISTT, while not restricting total ROM. These findings suggest that MTT transfer may have potential as a surgical treatment for IISTTs.

Rotator Cuff Augmentation: Its Role and Best Practices.

Rotator cuff tears are a common source of pain and impairment in the shoulder. Healing of the rotator cuff tendons following repair has been associated with improved patient outcomes. While there have been many technical improvements in surgical techniques for rotator cuff repair, failure rates are still surprisingly high. Augmentation of these repairs has been shown to help with fixation biomechanics as well as healing rates. The described types of augments include autograft, allograft, xenograft, and synthetic options. This report reviews the commonly available types of augments and some of the outcomes associated with their use.

Surgeon idiosyncrasy is a key driver of cost in arthroscopic rotator cuff repair: a time-driven activity-based costing analysis.

Delivering high-value orthopedic care requires optimizing value, defined as health outcomes achieved per dollar spent. Published literature is stippled with inaccurate proxies for cost, including negotiated reimbursement rates, fees paid, or listed prices. Time-driven activity-based costing (TDABC) offers a more robust and accurate approach to calculating cost, including shoulder care. In the present study, we sought to determine the drivers of total cost in arthroscopic rotator cuff repair (aRCR) using TDABC. Consecutive patients undergoing aRCR at multiple sites associated with a large urban health care system between January 2019 and September 2021 were identified. Total cost was determined using TDABC methodology. The episode of care was defined by 3 phases: preoperative, intraoperative, and postoperative care. Patient, procedure, rotator cuff tear morphology, and surgeon characteristics were collected. Bivariate analysis was performed across all characteristics between high-cost (top decile) and all other aRCRs. Multivariable linear regression was used to identify the key cost drivers. In total, 625 aRCRs performed by 24 orthopedic surgeons and 572 aRCRs performed by 13 orthopedic surgeons were included in the bivariate and multivariable linear regression analyses, respectively. By TDABC analysis, total aRCR cost varied 6-fold (5.9×) from least to most costly. Intraoperative costs accounted for 91% of average total cost, followed by preoperative costs and postoperative costs (6% and 3%, respectively). Biologic adjuncts (regression coefficient [RC] 0.54, 95% confidence interval [CI] 0.49-0.58, P<.001) and surgeon idiosyncrasy (RC of highest-cost surgeon 0.50, 95% CI 0.26-0.73, P<.001) were the major cost drivers in aRCR. Patient age, comorbidities, number of rotator cuff tendons torn, and revision surgery were not significantly associated with total cost. The amount of tendon retraction (RC 0.0012, 95% CI 0.000020-0.0024, P=.046), average Goutallier grade (RC 0.029, 95% CI 0.0086-0.049, P=.005), and the number of anchors used (RC 0.039, 95% CI 0.032-0.046, P < .001) were also significantly associated with cost, but with far smaller effect sizes. Episode of care costs vary nearly 6-fold in aRCR and are almost exclusively dictated by the intraoperative phase. Tear morphology and repair technique contribute to cost, although the largest cost drivers of aRCR are the use of biologic adjuncts and surgeon idiosyncrasy, defined as something a surgeon does or does not do that impacts total cost and is not controlled for in the current analysis. Future work should seek to better delineate what these surgeon idiosyncrasies may represent.

Single-row or Double-row Rotator Cuff Repair.

Rotator cuff tears are potentially a career-ending injury for athletes. The surgeon must identify which patients will benefit from surgical repair. The factors to consider are age, type of sport, time since injury, athlete's level, and the patient's expectations. An essential and independent fact determining the surgical treatment is whether the damage is due to overuse or from a traumatic/collision injury. Some sports are more demanding than others resulting in different return-to-participation (RTP) rates. This RTP return rate can present a real challenge and more so by a desire to reach the pre-injury level of play. The incidence of rotator cuff tearing varies from one sport to another. In football players this can be 12% whereas for tennis players this incidence is 4% to 17%. The RTP rate must be considered when making treatment decisions and is influenced by the level of the athlete: for professional athletes, the rate is 61%, and for recreational 73%. When the surgeon and the patient decide on the surgical treatment, the surgeon must consider whether to perform a double-row or a single-row rotator cuff tendon repair. The decision-making and the surgical technique will be addressed.

Subacromial Balloon Spacer: When to Use This?

The subacromial balloon spacer is a novel treatment option for the management of massive irreparable rotator cuff tears. This device is introduced into the glenohumeral joint and acts to alleviate the acromiohumeral impingement, caused by the massive irreparable rotator cuff tear. The device also redistributes the tension around the adjacent muscles in the joint, allowing them to compensate for the torn rotator cuff tendons. By doing so, the balloon can act as a "rehabilitation accelerator", ultimately resulting in improved shoulder pain and function. Adherence to balloon indications when selecting the appropriate patient is necessary, and these include an irreparable posterosuperior rotator cuff tear, with preserved subscapularis function, minimal to no osteoarthritis, and the ability to forward flex to 90 degrees. Clinical studies have demonstrated promising potential regarding the benefit of the balloon, with numerous studies demonstrating great outcomes after its implantation. Nevertheless, future research remains necessary to render the evidence behind its utility unequivocal.

Rotator Cuff Tendon Dimensional Variability, Novel Patient-Specific Measurement Method—Morphological Measurement for Rotator Cuff Tendon

Introduction: The shoulder rotator cuff (RC) is crucial to shoulder function and involvement in shoulder pathology. RC tears have been extensively studied, and several classifications have been devised to quantify their magnitude. Various RC measurement techniques were introduced previously, utilizing cadaveric specimens, X-rays, CT scans, and MRI with different results published regarding humeral heads’ different plane diameters and the correlation to age, gender, and height. There are very few studies measuring RC length in the general population. Purpose: We aimed to assess the geometrical relation between rotator cuff tendon length and humeral head sagittal and axial diameters. Methods: A total of 100 shoulder MRI scans of labral tear-suspected patients were reviewed, and the geometrical parameters of the rotator cuff length and proximal humerus sagittal and axial diameters were measured. Results: The healthy population has wide variability in humeral diameter and rotator cuff length. We found a high correlation between humeral head sagittal and axial plane diameters and the rotator cuff tendon dimension. The orthogonal plane diameters disagree with the humeral head being round but rather spheric. The rotator cuff length changes according to the patient’s gender and height. Conclusion: This is a novel method for rotator cuff measurement, description, and classification according to the percentage of tear instead of length (cm). This method is more clinically oriented and relevant than most other previous methods.

Redefining superior escape of the humeral head: A radiographic and magnetic resonance imaging study

Background The underlying shoulder pathology in radiographic superior escape of the humeral head and association between acromiohumeral interval (AHI) on radiographs and magnetic resonance imaging (MRI) are poorly understood. Methods A retrospective review of shoulder radiographs and MRI scans was undertaken. AHI was measured using both modalities. Deltoid bulk, long head of biceps brachii subluxation/tear, and rotator cuff disease (tendon involvement, severity, fatty infiltration) were noted using MRI. Results A total of 167 patients were included. MRI measurements of AHI were significantly smaller than radiographic measurements ( p = 0.010). AHI was significantly smaller in patients with at least one partial or full thickness rotator cuff tear ( p &lt; 0.0001) and in patients with increased fatty infiltration based on Goutallier grade ( p = 0.004). In the presence of two or more tendon tears, long head of biceps brachii rupture was associated with superior escape ( p &lt; 0.001). In patients with superior escape (AHI &lt;6 mm), the number of rotator cuff tendon tears ranged from 0 to 3 and Goutallier grades from 0 to 4 representing a wide disease spectrum. Discussion Radiographic superior escape of the humeral head is correlated with full thickness rotator cuff tears, fatty infiltration, and long head of biceps brachii rupture. However, superior escape can occur with a single or no tendon injury with minimal fatty infiltration. Level of evidence Level III; Retrospective Case-Control Design; Prognosis Study.