Rotator Cuff Delamination Is Associated With Increased Tendon Retraction and Higher Fatty Muscle Infiltration: A Comparative Study on Arthroscopy and Magnetic Resonance Imaging

Schanda, Jakob E.; Eigenschink, Martin; Laky, Brenda; Schwinghammer, Andreas; Lanz, Ulrich; Pauzenberger, Leo; Heuberer, Philipp R.

doi:10.1016/j.arthro.2021.12.028

Cited by 14 publications

(14 citation statements)

References 42 publications

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“…The gold standard for diagnosing tears of rotator cuff tendons is considered to be MRI [ 33 ]. MRI showed a low sensitivity of 35.5% and excellent specificity of 100%, with only 57.3% diagnostic accuracy for diagnosing delaminated tears in 349 shoulders [ 34 ]. A positive predictive value of 100% and a negative predictive value of 44.2% were reported [ 34 ].…”

Section: Radiologic Diagnosis Of Delaminated Tears Using Mrimentioning

confidence: 99%

“…MRI showed a low sensitivity of 35.5% and excellent specificity of 100%, with only 57.3% diagnostic accuracy for diagnosing delaminated tears in 349 shoulders [ 34 ]. A positive predictive value of 100% and a negative predictive value of 44.2% were reported [ 34 ]. Even if there is no delamination on MRI, retraction of the tendon with a higher amount of fatty muscle infiltration might also indicate the presence of tendon delamination [ 34 ].…”

Section: Radiologic Diagnosis Of Delaminated Tears Using Mrimentioning

confidence: 99%

“…A positive predictive value of 100% and a negative predictive value of 44.2% were reported [ 34 ]. Even if there is no delamination on MRI, retraction of the tendon with a higher amount of fatty muscle infiltration might also indicate the presence of tendon delamination [ 34 ]. Surgeons can benefit from the knowledge of tendon delamination by performing surgery more quickly for larger delaminated tears and shorter conservative treatment followed by surgery for smaller delaminated tears [ 30 ].…”

Section: Radiologic Diagnosis Of Delaminated Tears Using Mrimentioning

confidence: 99%

“…Collectively, the presence of medium to large retracted delaminated tears is a negative prognostic factor in anatomic outcomes after single-row repair and affects the rate of tendon healing [ 20 , 50 , 51 , 52 , 53 ]. Similarly, tendon delamination is increased in larger rotator cuff tears, and tear size is closely associated with fatty muscle infiltration [ 34 , 54 ]. Therefore, the repair of the double-layered rotator cuff is important to ensure optimal healing of the tendons and reduce the risk of retears [ 34 , 35 ].…”

Section: Treatment and Clinical Outcomementioning

confidence: 99%

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Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation

Kim

Lee

2023

Diagnostics

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(1) Background: A delaminated tear is described as a horizontal split in the tendon substance. This review summarizes the clinical and radiologic characteristics of delaminated tears of the rotator cuff. (2) Methods: Initial radiological characteristics of a delaminated tear include the horizontal component of a partial-thickness tear determined using magnetic resonance (MR) arthrography. As demonstrated using indirect MR arthrography, the tear gradually progresses to be defined as either horizontal intrasubstantial splitting of the bursal and articular layers or differential retraction of the bursal and articular layers. (3) Results: The existence of delaminated tears is a poor prognostic factor in functional and morphologic outcomes after the repair of rotator cuff tendons and many surgical techniques have been introduced to solve this problem. Although the presence of a delaminated tear does not affect the arthroscopic repair outcome, the presence of medium-to-large, retracted delaminated tears may be an adverse negative prognostic factor after single-row repair. (4) Conclusion: Advances in imaging and surgical techniques have improved the detection of delaminated rotator cuff tears. Preoperative identification of delaminated tears on magnetic resonance imaging is clinically important because tailored surgical repair techniques must be chosen for successful outcomes.

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Section: Radiologic Diagnosis Of Delaminated Tears Using Mrimentioning

confidence: 99%

Section: Radiologic Diagnosis Of Delaminated Tears Using Mrimentioning

confidence: 99%

Section: Radiologic Diagnosis Of Delaminated Tears Using Mrimentioning

confidence: 99%

Section: Treatment and Clinical Outcomementioning

confidence: 99%

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Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation

Kim

Lee

2023

Diagnostics

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“…42 Degenerative changes such as tendon delamination, increased tendon retraction, or fatty muscle infiltration and atrophy as well as reduced bone mineral density at the humeral head are commonly observed in patients with chronic RC tears. 33,39 Despite technical innovations and surgical improvements toward arthroscopic double-row and transosseous equivalent repair procedures, 49 rerupture rates after arthroscopic RC repair (RCR) of 10% to 21% for medium-sized tears and 24% to 28% for large tears are reported within the first year after surgery. 20 Fatty muscle infiltration and atrophy usually present an irreversible process negatively affecting clinical and functional outcomes.…”

mentioning

confidence: 99%

Muscle-Specific Micro-Ribonucleic Acids miR-1-3p, miR-133a-3p, and miR-133b Reflect Muscle Regeneration After Single-Dose Zoledronic Acid Following Rotator Cuff Repair in a Rodent Chronic Defect Model

et al. 2022

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Background: Zoledronic acid improves bone microarchitecture and biomechanical properties after chronic rotator cuff repair (RCR) in rats. Besides the positive effects of zoledronic acid on bone mineral density and bone microarchitecture, bisphosphonates have positive effects on skeletal muscle function. Purposes/Hypothesis: The purposes of this study were to (1) longitudinally evaluate circulating bone- and muscle-specific serum micro-ribonucleic acids (miRNAs) and (2) investigate supraspinatus muscle tissue after tenotomy and delayed RCR in a rat model. It was hypothesized that zoledronic acid would improve muscle regeneration after chronic RCR in rats. Study design: Controlled laboratory study. Methods: A total of 34 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy (time point 1) with delayed transosseous RCR after 3 weeks (time point 2). All rats were sacrificed 8 weeks after RCR (time point 3). Animals were randomly assigned to 2 groups. One day after RCR, the control group was given 1 mL of subcutaneous saline solution, and the intervention group was treated with a subcutaneous single-dose of 100 µg/kg body weight of zoledronic acid. All 34 study animals underwent miRNA analysis at all 3 time points. In 4 animals of each group, histological analyses as well as gene expression analyses were conducted. Results: Circulating miRNAs showed significantly different expressions between both study groups. In the control group, a significant downregulation was observed for muscle-specific miR-1-3p ( P = .004), miR-133a-3p ( P < .001), and miR-133b ( P < .001). Histological analyses showed significantly higher rates of regenerating myofibers on the operated side (left) of both study groups compared with the nonoperated side (right; P = .002). On the nonoperated side, significantly higher rates of regenerating myofibers were observed in the intervention group compared with the control group ( P = .031). The myofiber cross-sectional area revealed significantly smaller myofibers on both sides within the intervention group compared with both sides of the control group ( P < .001). Within the intervention group, significantly higher expression levels of muscle development/regeneration marker genes embryonal Myosin heavy chain ( P = .017) and neonatal Myosin heavy chain ( P = .016) were observed on the nonoperated side compared with the operated side. Conclusion: An adjuvant single-dose of zoledronic acid after RCR in a chronic defect model in rats led to significant differences in bone- and muscle-specific miRNA levels. Therefore, miR-1-3p, miR-133a-3p, and miR-133b might be used as biomarkers for muscle regeneration after RCR. Clinical Relevance: Adjuvant treatment with zoledronic acid may improve muscle regeneration after chronic RCR in humans, thus counteracting fatty muscle infiltration and atrophy.

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Arthroscopic Management of Massive Rotator Cuff Tear

Heuberer¹,

Eigenschink²,

Pauzenberger³

2023

Arthroscopy and Endoscopy of the Shoulder

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Rotator Cuff Delamination Is Associated With Increased Tendon Retraction and Higher Fatty Muscle Infiltration: A Comparative Study on Arthroscopy and Magnetic Resonance Imaging

Cited by 14 publications

References 42 publications

Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation

Delaminated Tears of the Rotator Cuff: MRI Interpretation with Clinical Correlation

Muscle-Specific Micro-Ribonucleic Acids miR-1-3p, miR-133a-3p, and miR-133b Reflect Muscle Regeneration After Single-Dose Zoledronic Acid Following Rotator Cuff Repair in a Rodent Chronic Defect Model

Arthroscopic Management of Massive Rotator Cuff Tear

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