• Clinics in Shoulder and Elbow
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• v.22 no.3
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• pp.159-170
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• 2019

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.

• Clinics in Shoulder and Elbow
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• v.21 no.4
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• pp.207-212
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• 2018

Background: Delaminated rotator cuff tear is known to be a degenerative tear having a negative prognostic effect. This study undertook to compare the anatomical and clinical outcomes of delaminated tears and single layer tears. Methods: Totally, 175 patients with medium to large rotator cuff tears enrolled for the study were divided into 2 groups, based on the tear pathology: single layer tear (group 1) and delaminated tear (group 2). Preoperatively, length of the remnant tendon, muscle atrophy of supraspinatus (SS), and fatty degeneration of SS and infraspinatus (IS) muscles were assessed on magnetic resonance imaging (MRI). For follow-up, the repair integrity of the rotator cuff was evaluated by ultrasonography. Clinical outcomes were assessed by evaluating the Constant score (CS) and Korean Shoulder Score (KSS). Results: Retears were detected in 6 cases of group 1 (6.5%) and 11 cases of group 2 (13.3%). Although higher in group 2, the retear rate was significantly not different (p=0.133). Preoperative MRI revealed length of remnant tendon to be $15.46{\pm}3.60mm$ and $14.17{\pm}3.16mm$ (p=0.013), and muscle atrophy of SS (occupation ratio) was $60.54{\pm}13.15$ and $56.55{\pm}12.88$ (p=0.045), in group 1 and group 2, respectively. Fatty degeneration of SS and IS in both groups had no significant differences. Postoperatively, no significant differences were observed for CS and KSS values between the groups. Conclusions: Delaminated rotator cuff tears showed shorter remnant tendon length and higher muscle atrophy that correlate to a negative prognosis. These prognostic effects should be considered during delaminated rotator cuff tear treatment.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2009.03a
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• pp.210-210
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• 2009

For a bursal-side retracted laminated rotator cuff tear, simple repair of the retracted bursal-side rotator cuff might be insufficient because the repaired tendon could remain as an intratendinous tear of the rotator cuff. We present a repair method for intratendinous rotator cuff tears using the suture-bridge technique. We believe that this method helps to preserve the remnant rotator cuff tendon without tissue damage and restores the normal rotator cuff footprint in bursal-side delaminated rotator cuff tears.

• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.197-201
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• 2016

Background: The purpose of the study was to compare the degree of degeneration of the articular and bursal layers of delaminated supraspinatus tendons based on histological examination. Methods: Fifty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from the lateral torn edges of the articular and bursal layers of the delaminated tear. Harvested samples were stained with H&E dye and evaluated based on a semi-quantitative grading scale. Results: There were no significant differences in the seven histological characteristics of tendon degeneration: fiber structure, fiber arrangement, round nuclei, regional variations in cellularity, vascularity, collagen stainability, and hyalinization between the articular and bursal layers of the delaminated rotator cuff tear (all p>0.05). Total degeneration scores of articular and bursal sides were $13.1{\pm}3.85$ points and $13.2{\pm}3.42$ points, respectively, and were not significantly different (p=0.958). Conclusions: The study demonstrates that tendon degeneration was similar in the articular and bursal sides of the delaminated full-thickness rotator cuff tear, suggesting that degeneration would be a main etiology for the rotator cuff tear not only in the articular side but also in the bursal side. Considering potential disadvantages of subacromial decompression, this study tentatively suggests routine use of subacromial decompression as well as the need for halting or recovery from rotator cuff degeneration for better rotator cuff repair.

• Journal of Korean Orthopaedic Sports Medicine
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• v.10 no.2
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• pp.61-68
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• 2011

Purpose: We evaluated the clinical outcome after arthroscopic repair in full thickness rotator cuff tears with and without delamination. Materials and Methods: From March 2006 to October 2008, we included 48 consecutive shoulders (31 males, 17 females; mean age 57.6 years; 45~68) who had arthroscopic double row repair for fullthickness tears of the rotator cuff. Mean rotator cuff tear size was 2.8 cm (range: 1.2~3.6) and the techniques of tendon-to-bone fixation varied according to the presence of delamination; separate row fixations of bursal and articular layer were used in delaminated tear. The mean follow-up was 26 months (range: 18~33) and functional and structural results were evaluated by American Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA) scale, isokinetic strength testing and magnetic resonance imaging (MRI) obtained mean 8 months (range:6~13) postoperatively. The patterns of delamination, age, sex, symptom duration, size of tear, satisfaction rate, retear rate ware compared and significance was set at p values < 0.05. Results: Postoperative functional shoulder score improved significantly in 44 shoulders (91.7%). Delamination was observed in 15 shoulders (31%) and it extended proximally and posteriorly in the majority of shoulders, and the articular layer was thicker (8/15, 53%) and more retracted (9/15, 60%) compared with the superficial bursal layer. Final follow up functional shoulder scores showed no differences between non-delaminated and delaminated tears and the presence of delamination had no correlations with sex, symptom duration, tear size and satisfaction rate, however, older age had more delaminated tears (p=0.041). Follow up MRI in 29 shoulders revealed that fourteen (48%) shoulders had complete healing; nine (31%), partial healing; six (21%), complete retear but the half of the retear group showed favorable clinical results. 79% (15/19) in non-delaminated tear and 80% (8/10) in delaminated tear were judged as healed tendon on MRI and double-layer double row repairs in delaminated tears resulted in nearly same rate of structural integrity of single-layer double row repairs (p=0.165). Conclusion: The incidence of delamination in our series was 31% and older age had more delaminated tears. Sex, symptom duration, preoperative size of the tear, functional results and satisfaction rate had no significant correlations with the presence of delamination. Nearly the same postoperative structural integrity was noted in both delaminated and non-delaminated tears.

• Clinics in Shoulder and Elbow
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• v.16 no.2
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• pp.84-93
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• 2013

Purpose: The purpose of this study was to evaluate the repair integrity and clinical outcomes of delaminated tears following arthroscopic layered suture bridge rotator cuff repair in a prospective fashion. Materials and Methods: A consecutive series of 67 patients with delaminated rotator cuff tears who underwent surgery using the arthroscopic Layered Suture Bridge Technique were followed prospectively. Of 67 shoulders, 26 patients were male and 40 patients were female (one patient had bilateral tears); the mean age was 58.8(40~76) years. The clinical evaluation was performed according to ASES, UCLA, and KSS (Korea Shoulder Scoring System) scores with an average follow up period of 33 months. Repair integrity was estimated using MRI, which was performed six months postoperatively. Results: The average clinical outcome in ASES, UCLA, and KSS scores showed significant improvement at the time of the final follow-up compared to preoperatively, from 50.2 to 92.3, 15 to 31.3, and 54.4 to 90.7, respectively (p<0.001 for all scores). Follow up by MRI showed that 16 shoulders had a type-I; 14, a type-II; five, a type-III; two, a type-IV; one, a type-V re-tear. The overall rate of re-tear (types IV and V) was 7.9%. Conclusion: Use of the Arthroscopic Layered Suture Bridge Technique can result in improved functional and structural outcome in cases of delaminated rotator cuff tear.