DOI QR코드

DOI QR Code

Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment

  • Kim, Jung-Han (Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine) ;
  • Jung, Soo-Hwan (Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine)
  • 투고 : 2019.02.15
  • 심사 : 2019.05.06
  • 발행 : 2019.09.01

초록

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.

키워드

참고문헌

  1. Iannotti JP, Deutsch A, Green A, et al. Time to failure after rotator cuff repair: a prospective imaging study. J Bone Joint Surg Am. 2013;95(11):965-71. doi: 10.2106/JBJS.L.00708.
  2. Ok HS, Kim BG, Choi WC, Hong CG, Kim JW, Kim JH. Clinical relevance of classifying massive rotator cuff tears: results based on functional and radiological findings after arthroscopic repair. Am J Sports Med. 2017;45(1):157-66. doi: 10.1177/0363546516667498.
  3. Ono Y, Davalos Herrera DA, Woodmass JM, Boorman RS, Thornton GM, Lo IK. Can grafts provide superior tendon healing and clinical outcomes after rotator cuff repairs?: a meta-analysis. Orthop J Sports Med. 2016;4(12):2325967116674191. doi: 10.1177/2325967116674191.
  4. Burkhart SS, Hartzler RU. Arthroscopic rotator cuff repair: how to avoid retear. Arthroscopy. 2019;35(1):12-3. doi: 10.1016/j.arthro.2018.11.002.
  5. Moezzi D. Editorial commentary: restoration of rotator cuff footprint anatomy is all that matters, no matter how we get there. Arthroscopy. 2018;34(12):3157-8. doi: 10.1016/j.arthro.2018.08.023.
  6. Han Y, Shin JH, Seok CW, Lee CH, Kim SH. Is posterior delamination in arthroscopic rotator cuff repair hidden to the posterior viewing portal? Arthroscopy. 2013;29(11):1740-7. doi: 10.1016/j.arthro.2013.08.021.
  7. Flurin PH, Landreau P, Gregory T, et al. Cuff integrity after arthroscopic rotator cuff repair: correlation with clinical results in 576 cases. Arthroscopy. 2007;23(4):340-6. doi: 10.1016/j.arthro.2007.01.005.
  8. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229-40. doi: 10.2106/JBJS.D.02035.
  9. Gwak HC, Kim CW, Kim JH, Choo HJ, Sagong SY, Shin J. Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2015;24(5):719-26. doi: 10.1016/j.jse.2014.09.027.
  10. MacDougal GA, Todhunter CR. Delamination tearing of the rotator cuff: prospective analysis of the influence of delamination tearing on the outcome of arthroscopically assisted mini open rotator cuff repair. J Shoulder Elbow Surg. 2010;19(7):1063-9. doi: 10.1016/j.jse.2009.12.020.
  11. Sonnabend DH, Watson EM. Structural factors affecting the outcome of rotator cuff repair. J Shoulder Elbow Surg. 2002;11(3):212-8. doi: 10.1067/mse.2002.122272.
  12. Iwashita S, Hashiguchi H, Okubo A, Yoneda M, Takai S. Characteristics of the patients with delaminated rotator cuff tear. SICOT J. 2018;4:28. doi: 10.1051/sicotj/2018022.
  13. Cha SW, Lee CK, Sugaya H, Kim T, Lee SC. Retraction pattern of delaminated rotator cuff tears: dual-layer rotator cuff repair. J Orthop Surg Res. 2016;11(1):75. doi: 10.1186/s13018-016-0407-9.
  14. Bierry G, Palmer WE. Patterns of tendon retraction in fullthickness rotator cuff tear: comparison of delaminated and nondelaminated tendons. Skeletal Radiol. 2019;48(1):109-17. doi: 10.1007/s00256-018-3013-6.
  15. Mochizuki T, Nimura A, Miyamoto T, Koga H, Akita K, Muneta T. Repair of rotator cuff tear with delamination: independent repairs of the infraspinatus and articular capsule. Arthrosc Tech. 2016;5(5):e1129-34. doi: 10.1016/j.eats.2016.06.004.
  16. Mori D, Funakoshi N, Yamashita F. Arthroscopic laminaspecific double-row fixation for large delaminated rotator cuff tears. Arthrosc Tech. 2014;3(6):e667-71. doi: 10.1016/j.eats.2014.08.004.
  17. Kim KC, Rhee KJ, Shin HD, Kim PS. Arthroscopic footprint reconstruction of bursal-side delaminated rotator cuff tears using the suture-bridge technique. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):840-3. doi: 10.1007/s00167-009-0730-3.
  18. Opsomer GJ, Gupta A, Haeni DL, et al. Arthroscopic doublelayer lasso loop technique to repair delaminated rotator cuff tears. Arthroscopy. 2018;34(11):2943-51. doi: 10.1016/j.arthro.2018.06.024.
  19. Park JY, Lhee SH, Oh KS, Moon SG, Hwang JT. Clinical and ultrasonographic outcomes of arthroscopic suture bridge repair for massive rotator cuff tear. Arthroscopy. 2013;29(2):280-9. doi: 10.1016/j.arthro.2012.09.008.
  20. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am. 2007;89(5):953-60. doi: 10.2106/JBJS.F.00512.
  21. Fukuda H. The management of partial-thickness tears of the rotator cuff. J Bone Joint Surg Br. 2003;85(1):3-11. https://doi.org/10.2106/00004623-200300003-00002
  22. Resnick D. Diagnosis of bone and joint disorders. 4th ed. Philadelphia: Saunders; 2002. 3100-2.
  23. Ellman H. Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res. 1990;(254):64-74.
  24. Sonnabend DH, Yu Y, Howlett CR, Harper GD, Walsh WR. Laminated tears of the human rotator cuff: a histologic and immunochemical study. J Shoulder Elbow Surg. 2001;10(2):109-15. doi: 10.1067/mse.2001.112882.
  25. Lee SY, Lee JK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results. Radiology. 2002;224(2):470-6. doi: 10.1148/radiol.2241011261.
  26. Walz DM, Miller TT, Chen S, Hofman J. MR imaging of delamination tears of the rotator cuff tendons. Skeletal Radiol. 2007;36(5):411-6. doi: 10.1007/s00256-006-0265-3.
  27. Reilly P, Amis AA, Wallace AL, Emery RJ. Mechanical factors in the initiation and propagation of tears of the rotator cuff. Quantification of strains of the supraspinatus tendon in vitro. J Bone Joint Surg Br. 2003;85(4):594-9.
  28. Sano H, Wakabayashi I, Itoi E. Stress distribution in the supraspinatus tendon with partial-thickness tears: an analysis using two-dimensional finite element model. J Shoulder Elbow Surg. 2006;15(1):100-5. doi: 10.1016/j.jse.2005.04.003.
  29. Kim YS, Kim JM, Bigliani LU, Kim HJ, Jung HW. In vivo strain analysis of the intact supraspinatus tendon by ultrasound speckles tracking imaging. J Orthop Res. 2011;29(12):1931-7. doi: 10.1002/jor.21470.
  30. Nakajima T, Rokuuma N, Hamada K, Tomatsu T, Fukuda H. Histologic and biomechanical characteristics of the supraspinatus tendon: reference to rotator cuff tearing. J Shoulder Elbow Surg. 1994;3(2):79-87. doi: 10.1016/S1058-2746(09)80114-6.
  31. Huang CY, Wang VM, Pawluk RJ, et al. Inhomogeneous mechanical behavior of the human supraspinatus tendon under uniaxial loading. J Orthop Res. 2005;23(4):924-30. doi: 10.1016/j.orthres.2004.02.016.
  32. Clark JM, Harryman DT 2nd. Tendons, ligaments, and capsule of the rotator cuff. Gross and microscopic anatomy. J Bone Joint Surg Am. 1992;74(5):713-25. https://doi.org/10.2106/00004623-199274050-00010
  33. Matsuki K, Murata R, Ochiai N, et al. Histological assessment of delamination observed in rotator cuff tears. Shoulder Jt. 2006;30(3):461-4. doi: 10.11296/katakansetsu1977.30.3_461.
  34. Tanaka M, Nimura A, Takahashi N, et al. Location and thickness of delaminated rotator cuff tears: cross-sectional analysis with surgery record review. JSES Open Access. 2018;2(1):84-90. doi: 10.1016/j.jses.2017.11.004.
  35. Choo HJ, Lee SJ, Kim JH, et al. Delaminated tears of the rotator cuff: prevalence, characteristics, and diagnostic accuracy using indirect MR arthrography. AJR Am J Roentgenol. 2015;204(2):360-6. doi: 10.2214/AJR.14.12555.
  36. Kim CW, Kim JH, Gwak HC, Park JH. The comparison of outcomes between delaminated and nondelaminated rotator cuff tear repair: is delamination a negative prognostic factor? J Shoulder Elb Surg. 2017;26(2):216-24. doi: 10.1016/j.jse.2016.09.015.
  37. Zilber S, Carillon Y, Lapner PC, Walch G, Nove-Josserand L. Infraspinatus delamination does not affect supraspinatus tear repair. Clin Orthop Relat Res. 2007;458:63-9. doi: 10.1097/BLO.0b013e31803b8da7.
  38. Cheon SJ, Kim JH, Gwak HC, Kim CW, Kim JK, Park JH. Comparison of histologic healing and biomechanical characteristics between repair techniques for a delaminated rotator cuff tear in rabbits. J Shoulder Elbow Surg. 2017;26(5):838-45. doi: 10.1016/j.jse.2016.10.005.
  39. Kim YS, Lee HJ, Jin HK, Kim SE, Lee JW. Conventional en masse repair versus separate double-layer double-row repair for the treatment of delaminated rotator cuff tears. Am J Sports Med. 2016;44(5):1146-52. doi: 10.1177/0363546516628869.
  40. Nakamizo H, Horie R. Comparison of en masse versus duallayer suture bridge procedures for delaminated rotator cuff tears. Arthroscopy. 2018;34(12):3150-6. doi: 10.1016/j.arthro.2018.06.054.
  41. Kim SJ, Choi YR, Lee HH, Chun YM. Surgical results of delaminated rotator cuff repair using suture-bridge technique with all-layers or bursal layer-only repair. Am J Sports Med. 2016;44(2):468-73. doi: 10.1177/0363546515615573.
  42. Kwon J, Lee YH, Kim SH, Ko JH, Park BK, Oh JH. Delamination does not affect outcomes after arthroscopic rotator cuff repair as compared with nondelaminated rotator cuff tears: a study of 1043 consecutive cases. Am J Sports Med. 2019;47(3):674-81. doi: 10.1177/0363546518817764.

피인용 문헌

  1. Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear vol.9, pp.3, 2019, https://doi.org/10.1177/2325967121990423