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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