Sunday, June 7, 2015

Rotator cuff repair - is the repaired tendon normal?

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

These authors reviewed 65 patients with delaminated rotator cuff tears. The delaminated tears were divided into full-thickness delaminated tears and partial-thickness delaminated tears. Cuff integrity was evaluated by computed tomography orthography. They found that the mean medial extension in the full-thickness and partial-thickness delaminated tears was 18.1 ± 6.0 mm and 22.7 ± 6.3 mm, respectively (P = .0084). The posterior extension into the supraspinatus and the infraspinatus was 36.9% and 32.3%, respectively, in the full-thickness delaminated tears, and it was 27.7% and 3.1%, respectively, in the partial-thickness delaminated tears (P = .0043). With regard to cuff integrity, 35 cases of anatomic healing, 10 cases of partial healing defects, and 17 cases of retear were detected. Among the patients with retear and partial healing of the defect, all the partially healed defects showed delamination. Three retear patients showed delamination.

Comment: These authors excluded traumatic tears and the average patient age was 60 years. One can surmise, therefore, that these were degenerative tears. The data shows that 35 of 65 had anatomic healing, 17 had full thickness retears and 10 had partial failure of the repair (all of which demonstrated delimitation).  The data show that cuff repair has a limited ability to restore normal rotator cuff anatomy and, presumably, strength.

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