Heuberer reports no relevant financial disclosures.
Published results showed delaminated rotator cuff tears had significantly greater tendon retraction and a higher amount of fatty muscle infiltration of the supraspinatus and infraspinatus.
Philipp R. Heuberer, MD, and colleagues retrospectively compared MRI scans of patients who underwent arthroscopic rotator cuff repair from 2013 to 2015 to intraoperative findings and categorized the prevalence of tendon delamination, tendon retraction and fatty muscle infiltration according to different rotator cuff tear patterns. Researchers used the global retraction index, a description individually assessing tendon retraction in MRI scans of all visible layers, to compare the amount of tendon retraction of delaminated and non-delaminated rotator cuff tears.
Among 349 shoulders, results showed 66.2% of patients had tendon delamination. Researchers found rotator cuff delamination in 84.6% of posterosuperior rotator cuff tears. Researchers also noted a significantly higher global retraction index and higher fatty muscle infiltration of the supraspinatus and infraspinatus among delaminated rotator cuff tears. To detect rotator cuff delamination, MRI had an accuracy of 57.3%, a positive predictive value of 100% and a negative predictive value of 44.2%, according to results.
Philipp R. Heuberer
“This study reveals [that] if delamination cannot be detected on MRI, it is not said that it can be encountered during arthroscopy. If it is already seen on MRI, it is a certain sign of a chronic long-standing rotator cuff tear with a higher grade of fatty muscle infiltration,” Heuberer told Healio. “If only one tendon layer is present on MRI together with a high grade of muscle atrophy, a massive cuff tear with tendon substance defect is highly probable.”
When delamination is present on MRI, Heuberer said surgeons should perform a double-layer reconstruction, as a single-layer reconstruction has been found to have a higher failure rate. He added an examination of muscle atrophy and fatty infiltration is important when delamination is not visible to determine the repair strategy.
“Especially for the patient, it is important to know already before surgery the probability of repairability, retear rate and rehabilitation phase,” Heuberer said. “A one-size-fits-all approach is no longer sustainable. Nowadays, medical knowledge allows for a custom-made surgical and rehabilitation strategy for every patient already before surgery. Assessing tendon delamination is one piece of the puzzle.”