Saturday, December 6, 2014

Many torn cuff tendons are delaminated - evidence of tendon degeneration


Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair

These authors found MRI evidence that approximately half of rotator cuff tears show evidence of tendon delamination,  defined as a horizontal tear occurring between rotator cuff layers.

They reviewed 65 patients with delaminated rotator cuff tears. There was medial and posterior extension of both full-thickness and partial-thickness delaminated tears.

35 of their repairs healed, 10 had partial healing and 17 of the repairs retore. All of the partially healed defects showed delamination .  26 of 35 anatomically healed cases showed remaining intrasubstance cleavage after bone to tendon healing.

Their 26% retear rate is consistent with that in our recent review of the literature.

Comment: This study, like the prior post, supports the view that rotator cuff failure is predominantly a degenerative process and that surgical repair of degenerated tissue may not durably reattach the tendon bone. We should always keep in mind the admonition of H. L. McLaughlin in 1962: "The wise surgeon, realizing that he may find little but rotten cloth to see, will operate only by necessity and make a carefully guarded prognosis."

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Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).