Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment

Kim, Jung-Han; Jung, Soo-Hwan

doi:10.5397/cise.2019.22.3.159

Cited by 11 publications

(25 citation statements)

References 42 publications

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“…These tears can occur in the bursal surface, the articular surface, or the tendon intrasubstance [ 7 , 8 ]. The latter is called a “delaminated tear” and is described as a horizontal split of the tendon substance [ 9 , 10 ]. A delaminated tear is located between the articular and bursal layers of the tendon, with or without articular or bursal side tears [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In some delaminated tears, intratendinous fibers separated by horizontal splitting are retracted to varying degrees [ 7 , 12 , 13 ]. Identifying the delaminated tear in preoperative MRI is important because arthroscopic detection is difficult when there are no accompanying articular or bursal side tears [ 8 , 10 ]. Thus, it is imperative to determine the precise location and size of the delaminated tears of the rotator cuff preoperatively.…”

Section: Introductionmentioning

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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kim

Lee

2023

Diagnostics

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“…21 En masse repair is performed by passing a suture through the bursal and articular layers simultaneously. 19 Although en masse repair shows favorable results, 10,11,19 individual repair of each layer, known as layer-by-layer repair, has been recommended for anatomic restoration. 7,25 The goal of layered repair is to prevent tension and length mismatch between the layers.…”

mentioning

confidence: 99%

“…The reported incidence of delaminated RCTs is between 32% and 88%. 10 Boileau et al 2 reported delaminated tears in 32% of patients after arthroscopic repair of medium or large chronic full–thickness RCTs. Han et al 6 reported an incidence of 88%.…”

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confidence: 99%

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

2022

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Background: Because the articular layer is more prone to retraction than the bursal layer of the supraspinatus tendon, it is important to restore each layer anatomically while repairing delaminated rotator cuff tears (RCTs). Purpose: To compare clinical outcomes and tendon integrity between knotless layer–by–layer and conventional en masse repair techniques for delaminated RCTs. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively reviewed data from 174 consecutive patients with delaminated RCTs treated by arthroscopic suture bridge repair. Only 115 patients with medium to large supraspinatus tears with delamination were included. The 33 patients treated using the knotless layer–by–layer technique (group 2) were matched 1:1 with patients treated using en masse repair with the suture bridge technique (group 1) based on propensity scores. Tendon thickness was measured on magnetic resonance imaging (MRI). Signal changes in the bursal, articular, and intratendinous layers were assessed using T2-weighted MRI. Results: Postoperatively, statistically significant improvements were seen in both groups compared with preoperatively functional scores. At the final follow–up, there was a statistically significant difference in the Constant score, which was higher in group 2 than in group 1 (91.4 ± 6.0 and 84.3 ± 16.4, respectively; P = .005). There was 1 case of a retear in each group, representing a 3% retear rate. Group 2 had thicker tendons than group 1 (6.9 ± 1.1 and 6.0 ± 1.2 mm, respectively; P = .017). On T2-weighted MRI, a low signal intensity in the articular layer was more common in group 2 ( P = .046). Conclusion: En masse repair using the suture bridge technique and the knotless layer–by–layer technique were both effective. Regarding tendon healing, no significant differences were seen in retear rates. However, superior results in terms of the Constant score, tendon thickness, and signal intensity in the articular layer were observed using the knotless layer–by–layer technique.

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“…Although the term delamination is commonly used, it has not been clearly defined. 15 Various definitions are used, and there is no standard classification depending on radiologic images or arthroscopic findings. 6,17 Recently, the "everted type," bursal-sided, partial-thickness tear was reported as being associated with worse pain and range of motion (ROM) preoperatively than a simple bursal-sided tear.…”

mentioning

confidence: 99%

Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

Kim

Byun

Han

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Although everted bursal flaps of delaminated tears have been reported, few studies have reported radiologic images, arthroscopic findings, and clinical results after repair. Purpose: To compare the repair outcomes of everted delaminated tears with those of classic delaminated supraspinatus tears. Study Design: Cohort study; Level of evidence, 3. Methods: Among 153 patients who underwent arthroscopic rotator cuff repair for a delaminated supraspinatus tear, everted bursal flap tears were observed in 24 patients upon arthroscopy (group A). Another 24 patients with classic delaminated supraspinatus tears, matched for age and sex, were selected for group B. Magnetic resonance imaging (MRI) and ultrasonography were performed preoperatively and postoperatively. Patients were evaluated using a visual analog scale (VAS) for pain as well as functional scores (American Shoulder and Elbow Surgeons [ASES] score, Constant score, and University of California Los Angeles shoulder score). Scores were compared preoperatively and at final follow-up (mean follow-up, 32 months). Results: Patients in both groups A and B reported improved VAS and functional scores at the final follow-up. In group A, preoperative VAS scores were higher and functional scores were poorer than in group B. Subacromial effusions with tendon swelling on preoperative MRI were more common in group A. During follow-up ultrasonography, group A patients exhibited persistent subacromial effusion. However, VAS scores at final follow-up were significantly better in group A (0.4 ± 0.7) than in group B (1.6 ± 1.4) ( P < .001), and ASES scores at final follow-up were better in group A (84.3 ± 4.3) than in group B (77.0 ± 10.2) ( P = .005). Conclusion: Everted bursal flap delaminated tears were associated with higher VAS scores and poorer functional scores preoperatively. Although subacromial effusions were experienced by group A during the early postoperative period, clinical outcomes at final follow-up were significantly better for everted delaminated tears compared with classic delaminated tears.

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Delaminated Rotator Cuff Tear: Concurrent Concept and Treatment

Cited by 11 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

A Propensity Score–Matched Comparison Between Knotless Layer-by-Layer and En Masse Suture Bridge Techniques for Delaminated Rotator Cuff Tears

Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

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