Tendon stump type on magnetic resonance imaging is a predictive factor for retear after arthroscopic rotator cuff repair

Ishitani, Eiichi; Harada, Nobuya; Sonoda, Yuri; Okada, Fumi; Yara, Takahiro; Katsuki, I.

doi:10.1016/j.jse.2019.05.012

Cited by 15 publications

(20 citation statements)

References 14 publications

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“…14 On the other hand, it has recently been suggested that hyperlipidemia alone may not be a risk factor for retear after rotator cuff surgery. 3,23 In the present study, similar to Ishitani et al, 17 no association was found between Goutallier classification, hyperlipidemia, or tear size and stump classification. In our opinion, stump classification is an assessment of rotator cuff tendon quality, and excessive traction on a degenerated rotator cuff due to fatty degeneration may lead to retear.…”

Section: Discussionsupporting

confidence: 87%

“…Stump type 3, which has a high-intensity rotator cuff tear to the deltoid, has a significantly higher retear rate (17.7%) after ARCR surgery than do type 1 (3.4%) and type 2 (4.9%). 17 Evaluation using stump classification based on MRI can help in the selection of suture techniques and postoperative therapies. 17 This classification is considered an indicator of retear in clinical settings, but no study has performed histological evaluation by stump classification.…”

Section: Discussionmentioning

confidence: 99%

“…32 Tissue from the rotator cuff was obtained intraoperatively from 30 patients who underwent arthroscopic surgery for rotator cuff tears. Stump classification was based on the report by Ishitani et al 17 (Figure 1). Patients were categorized based on stump classification as follows (Figure 2): 11 patients in the stump type 1 group (mean age, 62.0 years; 5 men and 6 women), 9 in the stump type 2 group (mean age, 63.8 years; 4 men and 5 women), and 10 in the stump type 3 group (mean age, 60.0 years; 5 men and 5 women).…”

Section: Isolation Of Human Rotator Cuff Samplesmentioning

confidence: 99%

“…43 Although rotator cuff tears can occur because of trauma, most are caused by age-related degeneration. 29 Recently, Ishitani et al 17 reported stump classification using the signal intensity ratio between the torn tendon site and deltoid muscle in the coronal view of T2-weighted fat-suppressed magnetic resonance imaging (MRI) scans as an indicator of rotator cuff fragility. The signal intensity was measured within a 10-mm 2 circle located 5 to 8 mm from the edge of the stump as the medial anchor suture and in the deltoid on the 45° line.…”

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confidence: 99%

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Biochemical Markers of Aging (Advanced Glycation End Products) and Degeneration Are Increased in Type 3 Rotator Cuff Tendon Stumps With Increased Signal Intensity Changes on MRI

et al. 2022

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Background: Advanced glycation end products (AGEs) are end products of protein glycation that bind to the receptor for AGEs (RAGE) and activate nicotinamide adenine dinucleotide phosphate oxidase (NOX), resulting in increased oxidative stress and rotator cuff fragility. Stump classification using the signal intensity ratio of the tendon rupture site to the deltoid muscle in the coronal view of T2-weighted fat-suppressed magnetic resonance imaging (MRI) scans is an indicator of clinical outcomes after rotator cuff repair surgery. Comparing the signal intensities of the deltoid (D) and rotator cuff tears (C), Ishitani et al. classified C/D <0.8 as type 1, 0.8 to 1.3 as type 2, and >1.3 as type 3. Hypothesis/Purpose: It was hypothesized that the oxidative stress and collagen degeneration that occur in the rotator cuff due to accumulation of AGEs can be assessed on MRI scans (stump classification). Therefore, this study aimed to compare AGE-related factors in the rotator cuff tear site tissues based on stump classification. Study Design: Descriptive laboratory study. Methods: The authors included 30 patients (11 with type 1, 9 with type 2, and 10 with type 3; mean age, 62.3 years) who underwent surgery for complete rotator cuff tears at our hospital. Tendon tissue was harvested from the torn rotator cuff site during surgery for tissue and cell evaluation. Results: There was no significant difference in the mean age according to stump classification. The number of patients with diabetes was significantly larger in type 3 than in the other types ( P < .05). Tissue evaluation showed significantly higher expression of AGE and RAGE staining in type 3 than in the other types (~6.7-fold; P < .01). Cell evaluation showed that the expression rates of reactive oxygen species and apoptosis were significantly higher in type 3 than in the other types (~4.3-fold; P < .01). Gene expression by real-time polymerase chain reaction showed significantly higher RAGE (~5.1-fold), NOX (~5.3-fold), and IL (~3.0-fold) in type 3 than in the other types ( P < .05). Conclusion: Stump classification type 3 exhibited the highest accumulation of AGEs and the highest oxidative stress and apoptosis, suggesting a high degree of degeneration and inflammation. Imaging based on stump classification reflects the degeneration and fragility of the torn rotator cuff site. Clinical Relevance: This study provides evidence of a relationship between stump classification, which reflects rotator cuff fragility on MRI, and pathologies related to advanced glycation end products.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Isolation Of Human Rotator Cuff Samplesmentioning

confidence: 99%

mentioning

confidence: 99%

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Biochemical Markers of Aging (Advanced Glycation End Products) and Degeneration Are Increased in Type 3 Rotator Cuff Tendon Stumps With Increased Signal Intensity Changes on MRI

et al. 2022

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“…The size, location, and degeneration degree of the supraspinatus/infraspinatus were estimated through the different planes of MRI. The tear size was obtained on the T2 oblique coronal and oblique sagittal planes with the maximal defect ( 10 , 11 ). To measure the thickness of teared tendon thickness, the maximal stump of supraspinatus/infraspinatus on the T2 oblique coronal plane.…”

Section: Methodsmentioning

confidence: 99%

Relevance between Proximal Humeral Migration and Rotator Cuff Tears

Zhang

et al. 2022

Front. Surg.

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BackgroundProximal humeral migration is common in patients with rotator cuff tears. In this study, we aimed to evaluate the relevance between proximal humeral migration and some rotator cuff tear-related factors.MethodsA total of 75 patients with unilateral rotator cuff tears were retrospectively included from August 2016 to January 2018 who underwent magnetic resonance imaging and X-ray examinations before enrollment. We introduced the upward migration index (UMI) to stratify the patients into three groups, Group A: 1 < UMI ≤ 1.3; Group B: 1.3 < UMI ≤ 1.4; and Group C: UMI > 1.4. Pearson correlation analysis and logistic regression analysis were used to evaluate the relationship between UMI and age, sex, body mass index, pain, fatty degeneration grade, tear size, and thickness of ruptured tendon. Then, the χ2 test and receiver operator characteristic curve were applied to measure the diagnostic value of UMI.ResultsThe average UMI was 1.34 ± 0.07, ranging from 1.16 to 1.48. For the Pearson correlation analysis, there was a negative correlation between UMI and tear size (R = −0.68, p < 0.01), and also, there was a negative correlation between UMI and the visual analogue scale score (R = 0.342, p < 0.01). What is more, there was a negative correlation between UMI and the fatty degeneration grade (R = −0.373, p < 0.01). Ordinal multinomial logistic regression analysis indicated that tear size (β = −1.825, p < 0.001) was the independent predictor of UMI, which was a risk factor for humeral upward migration. The cutoff points of UMI were 1.38 and 1.3 to determine tears and distinguish large tears from small ones.ConclusionsUMI is a good predictor for humeral upward migration, which is related to the tear size of posterosuperior cuff tears. When the UMI is <1.3, a large tear should be alerted. Combining physical examination and X-ray is helpful for evaluating rotator cuff tears.

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Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair

Takeuchi

Kozono

Nishii

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe Stump classification is significantly correlated with a retear after arthroscopic rotator cuff repair. However, no study has evaluated whether or not the stump classification is correlated with retear in the suture‐bridge or double‐row repair techniques. The aim of this study was to evaluate the relationship between a retear and the stump classification in the suture‐bridge and double‐row repair techniques. MethodsAmong 389 patients who underwent arthroscopic repairs of full‐thickness rotator cuff tears using suture‐bridge or double‐row repair techniques, 326 patients (median age 67.0 years; range 25–85) were included. There were 51 small, 172 medium, 83 large, and 20 massive tears. Two hundred forty patients were treated with the suture‐bridge technique, and 86 patients were treated with the double‐row technique. The following variables were analyzed: age, sex, the Cofield classification, anteroposterior and mediolateral tear size on preoperative MRI, global fatty degeneration index, and the stump classification. Cuff integrity was evaluated on magnetic resonance imaging at 6 months after surgery. The patients were divided into the intact and retear groups and the relationship between the variables and retear was evaluated by multivariate logistic regression analysis. ResultsThe overall retear rate was 10.1%. In the multivariate logistic regression analysis, the independent predictors of a retear were the stump classification type 3 (Odds ratio: 4.71, p = 0.0246), global fatty degeneration index (Odds ratio: 3.87, p = 0.0030), and anteroposterior tear size (Odds ratio: 1.07, p = 0.0077) in the suture bridge technique. In the double‐row technique, the independent predictors of retear were stump classification type 3 (Odds ratio: 7.82, p = 0.0348), and age (Odds ratio: 1.22, p = 0.0163). ConclusionThe stump classification was significantly correlated with retear in the suture‐bridge and double‐row repair technique. Stump classification type 3 was indicated to be an important risk factor for predicting retear. Level of evidenceIII

show abstract

Tendon stump type on magnetic resonance imaging is a predictive factor for retear after arthroscopic rotator cuff repair

Cited by 15 publications

References 14 publications

Biochemical Markers of Aging (Advanced Glycation End Products) and Degeneration Are Increased in Type 3 Rotator Cuff Tendon Stumps With Increased Signal Intensity Changes on MRI

Biochemical Markers of Aging (Advanced Glycation End Products) and Degeneration Are Increased in Type 3 Rotator Cuff Tendon Stumps With Increased Signal Intensity Changes on MRI

Relevance between Proximal Humeral Migration and Rotator Cuff Tears

Stump classification was correlated with retear in the suture-bridge and double-row repair techniques for arthroscopic rotator cuff repair

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