Degeneration Exists along the Entire Length of the Supraspinatus Tendon in Patients with a Rotator Cuff Tear

Abstract

Background: The purposes of the study were to examine rotator cuff tendon degeneration with respect to harvesting location, to determine a rationale for debridement of the torn end, and thus, to determine adequate debridement extent. Methods: Twenty-four patients with a full-thickness rotator cuff tear were included in the study. Tendon specimens were harvested during arthroscopic rotator cuff repair from three locations; from torn ends after minimal regularization of fraying (native end group, NE group), from torn ends after complete freshening of the frayed end (freshened end group, FE group), and from the macroscopically intact portion just distal to the musculotendinous junction (musculotendinous junction group, MTJ group). Control samples were harvested from patients admitted for surgery for proximal humerus fracture. Harvested samples were evaluated using a semi-quantitative grading scale. Results: Mean total degeneration scores in the NE group (13.3 ± 3.21), the FE group (12.5 ± 2.30), and in the MTJ group (10.8 ± 3.10) were significantly higher than those in the normal control group (5.0 ± 2.87; all p<0.001). Mean total degeneration score in the NE group was significantly higher than that in the MTJ group (p=0.012), but was not from that of the FE group. Mean total degeneration score in the FE group was not significantly different from that of the MTJ group. Conclusions: Tendon degeneration exists throughout the entire tendon to the macroscopically intact portion of full-thickness rotator cuff tear. Therefore, aggressive debridement to grossly normal appearing, bleeding tendon is unnecessary for enhancing healing after repair. (Clin Shoulder Elbow 2015;18(2):61-67)

Prognostic factors affecting structural integrity after arthroscopic rotator cuff repair: a clinical and histological study

“…In our study, however, no significant differences in tendon degeneration were found between patients with different-sized full-thickness rotator cuff tears. In several studies using the same histological grading system as that used in this study, the average total degeneration score for full-thickness tears ranged from 12 to 15 [ 24 , 25 ], suggesting that a total degeneration score of 12 or higher may indicate that tendon degeneration has already reached the end stages. The results of this study are consistent with those of previous studies [ 20 , 24 ].…”

“…In several studies using the same histological grading system as that used in this study, the average total degeneration score for full-thickness tears ranged from 12 to 15 [ 24 , 25 ], suggesting that a total degeneration score of 12 or higher may indicate that tendon degeneration has already reached the end stages. The results of this study are consistent with those of previous studies [ 20 , 24 ]. Because a full-thickness rotator cuff tear is the final stage in the rotator cuff tear spectrum, it is possible that any degenerative changes in the torn tendons may already have progressed to the end stage, which is why no significant differences of tendon degeneration were found between the healed and retear groups.…”

Similar Degree of Degeneration in the Articular and Bursal Layers of Delaminated Rotator Cuff Tear

“…Each slide was evaluated with a semi-quantitative grading scale of Aström and Movin modified by Maffulli. 6,17,18) The parameters included in the scale were fiber structure, fiber arrangement, rounding of nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. A 4-point scoring system was used; 0 indicates normal appearance, 1 slightly abnormal, 2 moderately abnormal, and 3 markedly abnormal.…”

“…Whole area of each slide was observed, and the most severely degenerated area, possibly expecting the worst score, was selected and used in the study. 6) Examination was performed by a fellowship trained orthopedic surgeon and pathologist. Each slide was evaluated with a semi-quantitative grading scale of Aström and Movin modified by Maffulli.…”

“…4) Whereas the exact etiology of rotator cuff tears remains to be elucidated, tendon degeneration has been recently considered as one of the most important reasons. [5][6][7][8] Delamination is defined as a horizontal split of the torn tendon end and is a common finding during arthroscopic shoulder surgery with a reported prevalence of 31% to 71%. [9][10][11] Whereas the exact mechanism of delamination is not known, it can occur between layers 2 and 3 due to different histological properties such as varying collagen direction and degeneration degree as well as biomechanical properties of the two layers.…”