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

천경아,김민성,김영주 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.5

Objective: To 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 Methods: The 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 articularsided, 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 interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. Results: The 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. Conclusion: MR 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. Objective: To 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 Methods: The 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 articularsided, 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 interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. Results: The 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. Conclusion: MR 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.

Progression of fatty degeneration of rotator cuff muscles after cuff repairs

Young Lae Moon,Boseon Kim,Sang Ha Park 대한정형외과 스포츠의학회 2015 Arthroscopy and Orthopedic Sports Medicine Vol.2 No.1

reBackground: To evaluate fatty degeneration and atrophy of rotator cuff muscles in patients with normal cuffs and in patients who received repairs of rotator cuff tears. Methods: We chose 328 patients with normal cuffs, henceforth called the “normal group”. The normal group was subcategorized according to age. Further, we chose 41 patients with cuff tears, henceforth called the “cuff tear group”, who had received reparative surgeries. The cuff tear group was divided into 2 subgroups: a cuff “repaired group” that rotator cuff tears were successfully repaired and a “re-tear group” that cuff repairs were unsuccessful and led to a re- tear. The repaired group included 30 patients and the re-tear group included 11 patients. The radiological parameters (fatty degeneration and atrophy) and clinical outcomes (visual analogue scale, UCLA, Constant, and Oxford scores) were evaluated. Results: We found that the extent of fatty degeneration and atrophy of the cuff muscles was irrespective of the aging process. Compared to the normal group, we found the cuff tear group had a significantly greater fatty degeneration and atrophy of the rotator cuff muscles. Within the cuff tear group, the re-tear group had a significantly more deteriorated fatty degeneration at the follow-up magnetic resonance imaging (MRI) than at the initial MRI (P = 0.024) and more muscle atrophy than the repaired group; there was no statistical significance. Although the clinical markers were more satisfactory in the repaired group than the re-tear group after surgery, there was no statistical significance. Conclusion: Fatty degeneration and atrophy of the rotator cuff muscles were not affected by the normal aging process. However, we found that fatty degeneration was accelerated following cuff tears even when the tear had been repaired. Lastly, we found that a preoperative fatty degeneration of more than grade 3 was associated with a higher re-tear rate of the rotator cuffs.

관절경적 회전근 개 봉합술 : 1 - 4년 추시 결과

박진영,정경태,멍예,박희곤,Park, Jin-Young,Chung, Kyung-Tae,Meng, Ye,Park, Hee-Gon 대한견주관절학회 2002 대한견주관절의학회지 Vol.5 No.1

Purpose : To compare and analyze the results of arthroscopic subacromial decompression and rotator cuff repair between partial rotator cuff tear and complete rotator cuff tear. Material and Methods : The authors studied 42 patients of rotator cuff tear with operation and followed over one year at Dankook university hospital from September, 1998 to March, 2001 The patient average age is 53 years and follow up period is 23 months (12-42mon1hs). We obtained 22 cases in the partial rotator cuff tear group and 20 cases in the complete rotator cuff tear group. In all cases, we used ASES methods to evaluated pain scale and function. Result : In the last follow up patients, the pain scale is decreased from 7.2 to 0.9 (ASES method : 34 to 91) in the partial rotator cuff tear group and from 7.6 to 1.2 (ASES method . 29 to 88) in the complete rotator cuff tear group, but there was no evidence of statistical difference between two groups (P>0.05). The range of motion after operation were increased in two groups. Excellent to good results were obtained 93% and 95% patients had pain relief and satisfied function. Conclusion : Arthroscopic subacromial decompression and arthroscopic rotator cuff repair showed good results for both of (ult-thickness and partial thickness rotator cuff tear patients in pain relief and improving the function.

단순 방사선 사진에서 견봉 및 상완골 대결절의 퇴행성 변화와 MRI상 회전근 개 파열 정도와의 연관성

최정윤(Jung-Yun Choi),염재광(Jae-Mwang Yum),송민철(Min-Cheol Song) 대한견주관절의학회 2013 대한견주관절의학회지 Vol.16 No.1

목적: 단순 방사선 사진상에서 견봉 및 상완골 대결절의 퇴행성 변화의 정도와 회전근 개 파열의 크기 사이의 연관성을 알아보고자 하였다. 대상 및 방법: 견관절의 자기 공명 영상을 시행한 퇴행성 회전근 개 파열 실험군 234예와 회전근 개 파열이 없는 대조군 284예 등 총 518예를 대상으로 하였다. 견관절 방사선 단순 촬영에서 퇴행성 변화의 정도를 관절와-상완 관절의 퇴행성 변화를 제외한 견봉과 대결절에서 골극의 길이와 형태의 변형에 따라 분류하였고, 자기 공명 영상에서 회전근 개의 파열의 정도 및 전층 파열의 크기를 분류하였다. 회전근 개의 파열의 정도와 크기에 따른 견봉 및 상완골 대결절의 퇴행성 변화 정도와의 연관성에 대해 알아 보았다. 결과: 견관절 단순 방사선 사진에서 보이는 견봉 및 상완골 대결절의 퇴행성 변화에 따른 MRI상 회전근개 파열의 정도는 유의한 차이를 보였고(p<0.001), 견봉 및 상완골 대결절의 단순 방사선상 퇴행성 변화가 증가할수록 회전근 개 파열의 크기가 커지는 경향이 있었으며(p<0.001), 부분층 파열 보다 전층 파열 가능성이 높은 것으로 나타났다(p<0.001). 또한 고령 및 여자에서 회전근 개의 파열이 더 심하다는 결과를 얻었다(p<0.001, p<0.001). 결론: 퇴행성 회전근 개 파열 환자에서 견관절의 단순 방사선 사진상 견봉 및 상완골 대결절의 퇴행성 변화가 심할수록 회전근 개 파열의 크기가 더 크고, 나이와 성별도 관련 인자 중 하나로 사료된다. Purpose: The purpose of this study is to analyze the correlation between the degree of torn rotator cuff as recorded by MRI and degenerative change of acromion and greater tuberosity of humerus determined by simple radiographs. Materials and Methods: Of the 518 cases included in this study, a group of 234 cases had a chronic rotator cuff tear and a control group of 284 cases had an intact rotator cuff in shoulder MRI. The degree of degenerative changes was classified according to the length of spur and morphological change of acromion and greater tuberosity through the true anteroposterior simple radiograph in supraspinatus outlet view. The degree of tear (partial-thickness or full-thickness tear) and the size of complete rotator cuff tear were analyzed according to the MRI findings of shoulder. The authors also evaluated the correlation between the degree and size of torn rotator cuff and the degenerative change of acromion and greater tuberosity. Results: There were significant differences in the size and extent of torn rotator cuff according to the age, sex and degenerative change of acromion and greater tuberosity of humerus (p<0.001). More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff (p<0.001). In addition, the higher degree and larger size of torn rotator cuff were noted in older age subjects (p<0.001) and in the female group (p<0.001). Conclusion: More degenerative changes of acromion and greater tuberosity in simple shoulder radiographs showed the increased degree and size of torn rotator cuff. Therefore, if a high degree of degenerative change of the acromion and greater tuberosity on simple radiograph is noted, the possibility of degenerative rotator cuff tear should be considered. In addition, the age and sex could be associative factors for larger size of torn rotator cuff.

회전근 개 파열에서 Apoptotic Cell의 발현과 조직병리학적 소견

서지훈(Ji-Hoon Suh),홍수헌(Soo-Heon Hong),박재범(Jae-Bum Park),김종민(Jong Min Kim),전재명(Jae-Myeung Chun) 대한정형외과학회 2009 대한정형외과학회지 Vol.44 No.4

목적: 회전근 개 파열 환자에서 파열 크기, apoptotic cell의 발현빈도(apoptotic index), 조직병리학적 소견들의 상호 연관성을 알아보고자 하였다. 대상 및 방법: 회전근 개 파열로 수술을 시행한 63예를 대상으로 하였으며, 소, 중, 대, 광범위 파열이 각각 2예, 22예, 22예, 17예였다. 조직병리학적 변화의 평가를 위해서는 H&E 염색을, apoptotic index 의 조사를 위해서는 TUNEL염색을 사용하였고, 이들과 파열 크기와의 관계를 연구 분석하였다. 결과: 파열의 크기에 따른 섬유 모세포의 조밀도, 활액막 비대층 및 혈관 증식의 정도 등은 통계적인 차이는 없었다. Apoptotic cell은 모든 예에서 관찰되었으며 주로 파열부위에 집중되어 있는 양상을 보였다. 파열 크기에 따른 apoptotic index는 소파열에서 58.50, 중파열에서 27.25, 대파열에서 33.29, 광범위 파열에서 31.96이었으며, 통계학적으로 유의한 차이는 없었다. 결론: 회전근 개 파열에서 apoptotic index나 섬유모세포 조밀도, 활액막 비대, 혈관증식 등의 조직병리 소견들은 파열의 크기에 따른 통계적으로 유의한 차이가 없었으며, 그들 지표 서로 간에도 상관관계가 없었다. Purpose: We analyzed the relationship between the size of the torn rotator cuff and the frequency of finding apoptotic cells (apoptotic index) or pathological degeneration in the rotator cuff. Materials and Methods: The edges of torn supraspinatus tendons were obtained from patients with rotator cuff tear (n=63). The study group consisted of 2 small, 22 medium, 22 large and 17 massive tears. For the histopathologic evaluation, the H&E stained sections of the torn supraspinatus tendons were examined. Apoptosis was detected with TUNEL assay. We analyzed the relationships between the tear size and the pathologic findings or the apoptotic index. Results: Significant differences could not be found for the fibroblast cellularity, thickening of the synovial lining and proliferation of blood vessels according to the size of the rotator cuff tear. All the specimens had apoptotic cells that were concentrated around the margin of the tear site. The apoptotic indexes according to the tear size were 58.50 for the small tears, 27.25 for the medium tears, 33.29 for the large tears and 31.96 for the massive tears. No significant correlation was found between the tear size and the apoptotic index. Conclusion: There were no significant differences in the apoptotic indices, the fibroblast cellularity, the thickening of the synovial lining and the proliferation of blood vessels according to the size of the rotator cuff tear, and there were no correlations between the apoptotic index and the histopathologic findings.

회전근개 파열의 진단 : 초음파 및 자기공명영상 소견과 수술소견의 비교 A Comparison of Ultrasonography, Magnetic Resonance Imaging and Operative Findings

빈성일,정상일 대한스포츠의학회 1995 대한스포츠의학회지 Vol.13 No.2

Twenty-two symptomatic patients with suspected tears of the rotator cuff were studied with MR imaging and ultrasonography to determine the ability of detecting the rotator cuff tears. All patients underwent surgery. 1. For 2 patients of complete tears, MR images and ultrasonography also showed complete tear. 2. For 20 patients of partial tears, MR images showed partial tears in 17 of 20 patients and complete tears in 3of 20 patients. Thus the sensitivity of MRI for presence of rotator cuff tear was 100% and that for partial tear, 85%, Ultrasonographic findings showed partial tears in 11 of 20 patients, complete tears in 7 patients and negative finding for tear in 2 patients. Thus the sensitivity of ultrasonography for rotator cuff tear was 90% and that for partial tear, 55%. This result shows that MR imaging is the excellent diagnostic method for rotator cuff tear and is useful for differential diagnosis of partial and complete tear. On the other hand, sonography is inappropriate for differential diagnosis of partial and complete tear, but it is appropriate for the diagnosis for rotator cuff tear itself. So, ultrasonography may be used as a screening method of rotator cuff tear.

Does strength deficit correlate with shoulder function in patients with rotator cuff tears? Characteristics of massive tears

Oh, Joo Han,Yoon, Jong Pil,Kim, Dong Hyun,Chung, Seok Won,Kim, Joon Yub,Lee, Hyun-Joo,Il, Seo,Park, Kyeong Hyeon,Lee, Hoseok Elsevier 2019 Journal of shoulder and elbow surgery Vol.28 No.10

<P><B>Background</B></P> <P>The correlation between shoulder strength deficits and function in rotator cuff tears remains uncertain. This study aimed to determine the correlation between shoulder strength deficits and shoulder function evaluated by various clinical scoring systems.</P> <P><B>Methods</B></P> <P>A total of 262 patients (mean age, 59.67 years [standard deviation, 8.06 years]) who underwent full-thickness rotator cuff repair were included. Patients in group I (n = 188) had small to large rotator cuff tears, whereas those in group II (n = 74) had massive rotator cuff tears. Demographic factors, isokinetic test results, and shoulder function evaluated using various scoring systems were obtained. Correlation differences according to severity of the rotator cuff tear were evaluated.</P> <P><B>Results</B></P> <P>We found weak correlations between shoulder strength deficits (peak torque and total work) and clinical outcomes in patients with rotator cuff tears (<I>r</I> = –0.288). For patients in group I (nonmassive tears), we found a weaker correlation (<I>r</I> = –0.242) according to the tear pattern. However, shoulder strength deficits in group II patients (massive tears) were strongly correlated with American Shoulder and Elbow Surgeons (<I>r</I> = –0.598), Constant (<I>r</I> = –0.582), and Short Form 36 (<I>r</I> = –0.511) scores, especially regarding internal rotator strength deficits.</P> <P><B>Conclusions</B></P> <P>Shoulder strength deficits measured via isokinetic testing and shoulder function were weakly correlated in patients with rotator cuff tears. However, shoulder strength deficits in patients with massive tears considerably worsened shoulder function and systemic disability, but not regional disability. In particular, internal rotator strength deficits were strongly correlated with poor shoulder function.</P>

회전근 개 부분 파열의 임상 양상 및 관절경 소견

권오수(Oh Soo Kwon),김양수(Yang Soo Kim),이규영(Kyoo Young Lee) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.2

목적: 회전근 개 부분 파열의 파열 위치에 따른 수술 전 임상 양상을 비교하고 관절경 소견에 따라 회전근개 파열을 분류하고자 하였다 대상 및 방법: 관절경하에서 확진된 138예의 회전근 개 부분 파열 환자를 대상으로 하였다. 각 군간에 동통, 관절운동 범위, 충돌 징후 등의 이학적 검사를 포함한 수술 전 임상 소견을 비교하였으며 관절경하 소견에 따라 부분 파열을 분류하였다. 결과: 관절측, 점액낭측, 양측 파열간에 수술 전 임상 양상은 통계학적으로 유의한 차이가 없었다. 관절경 소견상회전근 개 부분 파열은 5개의 형태로 분류될 수 있었다. 제 1형은 닳아 헤어진 소견(fraying)이 있는 경우이며, 제 2형은 섬유의 단열이 있으며 제 3형은 충판(flap)을 형성하거나 분획화(fragmentation)된 경우이다. 제 4형은 관절측과 점액낭측에 모두 파열이 존재하지만 양측간에 교통은 없는 경우이며 제 5형은 전층 파열로의 진행이 임박하였으나 최후의 건 섬유의 다양한 형태가 관찰되었다. 결론: 회전근 개 부분 파열의 진단에서 수술 전 이학적 검사를 통한 임상 양상에 따라 파열 위치를 예측하기는 어려울 것으로 사료된다. 관절경하 소견을 통한 새로운 분류가 회전근 개 부분 파열의 치료 방침을 결정하는데에 도움을 줄 수 있을 것으로 생각된다. Purpose: 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. Materials and Methods: 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. The partial thickness rotator cuff tears were classified according to the arthroscopic findings. Results: There was no significant difference in the clinical features between articular, bursal and both sides tears. Partial thickness rotator cuff tear can be divided into 5 groups. Type Ⅰ (n=41): fraying or fibrillation on surface of the cuff. Type Ⅱ (n=35): fiber disruptions with or without displacement. Type Ⅲ (n=38): flap tear or fragmentation. Type Ⅳ (n=16): both articular and bursal side tears without communications. Type Ⅴ (n=8): impending a full thickness tear. Conclusion: It is difficult to differentiate the clinical features based on the physical examinations according to the locations of tears. Newly designed classification may help in deternmining the appropriate arthroscopic treatment of a partial thickness rotator cuff tear.

회전근개 파열 환자의 파열 크기에 따른 견관절 최대 우력의 비교

전아영,유연식,강석원,장기언,서정훈,최은희 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.5

Objective: To investigate the peak torque of shoulder according to the size of the rotator cuff tear. Method: With 26 patients of unilateral rotator cuff tear, we measured the concentric isokinetic peak torque of shoulder, using Con-Trex isokinetic dynamometer (CMV AG, Deubendorf, Switzerland). We measured flexion, extension, abduction, adduction, external rotation, and internal rotation torques and calculated the peak toque ratio of flexion/ extension, abduction/adduction and external rotation/internal rotation. Before the test, we injected 1% lidocaine to the subacromial bursa to minimize the error that can be caused by pain. The difference of peak torque according to the size of tear was compared. Results: Comparing the peak torque between affected and sound side, significant difference in flexion, extension, abduction, adduction, internal rotation, and external rotation were shown, but there were no difference in peak torque's ratio in flexion/extension, abduction/adduction, and internal rotation/external rotation. When we compared the peak torque according to the tear size, it didn't show significant difference and also there were no difference of peak torque's ratio in flexion/extension, abduction/adduction, internal rotation/external rotation. Conclusion: When we measured the shoulder's strength of rotator cuff tear, peak torque decreased in all motion. But the peak torque's loss and peak torque’s ratio is not related with size of tear. Objective: To investigate the peak torque of shoulder according to the size of the rotator cuff tear. Method: With 26 patients of unilateral rotator cuff tear, we measured the concentric isokinetic peak torque of shoulder, using Con-Trex isokinetic dynamometer (CMV AG, Deubendorf, Switzerland). We measured flexion, extension, abduction, adduction, external rotation, and internal rotation torques and calculated the peak toque ratio of flexion/ extension, abduction/adduction and external rotation/internal rotation. Before the test, we injected 1% lidocaine to the subacromial bursa to minimize the error that can be caused by pain. The difference of peak torque according to the size of tear was compared. Results: Comparing the peak torque between affected and sound side, significant difference in flexion, extension, abduction, adduction, internal rotation, and external rotation were shown, but there were no difference in peak torque's ratio in flexion/extension, abduction/adduction, and internal rotation/external rotation. When we compared the peak torque according to the tear size, it didn't show significant difference and also there were no difference of peak torque's ratio in flexion/extension, abduction/adduction, internal rotation/external rotation. Conclusion: When we measured the shoulder's strength of rotator cuff tear, peak torque decreased in all motion. But the peak torque's loss and peak torque’s ratio is not related with size of tear.

Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment

Jung-Han Kim,Soo-Hwan Jung 대한견주관절의학회 2019 대한견주관절의학회지 Vol.22 No.3

Delaminated rotator cuff tear pertains to the horizontal split of the tendon substance. As reported previously, the presence of a delaminated tear and incidence of delaminated rotator cuff tear ranges from 38% to 92%. The different strain intensities applied across the rotator cuff tendon, and the shear stress between the bursal and articular layers seem to play a role in its pathogenesis. In a delaminated rotator cuff tear, the degree and direction of retraction between two layers differ, with accompanying intrasubstance cleavage. A surgeon therefore needs to consider and carefully evaluate the tear characteristics when repairing delaminated rotator cuff tear. Delaminated rotator cuff tear is considered to be a poor prognostic factor after rotator cuff repair, but numerous surgical repair techniques have been introduced and applied to resolve this problem. Recent literature has reported good clinical outcomes after delaminated rotator cuff repair.