Aradhana Mukherjea Venkatesan MD, Presenter: Nothing to Disclose

Benjamin Fritz MD, Abstract Co-Author: Nothing to Disclose

Ara Kassarjian MD, Abstract Co-Author: Nothing to Disclose

William Ewing Palmer MD, Abstract Co-Author: Nothing to Disclose

To determine the relationship between anteroposterior length of rotator cuff tear (RCT) and the proximal extent of tendon retraction, and to test the hypothesis that tendon delamination may cause a disproportionate degree of retraction of bursal or articular cuff fibers.

In 59 patients (32 male, 27 female, ages 18-79) who had full-thickness RCTs at surgery, we retrospectively reviewed MR images to measure the length of tear from anterior to posterior (centimeters). Two reviewers reached consensus. After a 4 month interval, we measured cuff retraction from the osseous attachment site to the proximal tendon margin. Whenever cuff delamination resulted in different degrees of retraction of bursal and articular tendon margins, we measured the distance to the more retracted margin. All MR images were acquired at 1.5T using dedicated shoulder coil and routine arthrographic or non-arthrographic protocol. IRB approval was obtained.

The anteroposterior length of RCT ranged from 2-50cms (mean = 28cms), and the retraction of tendon margin ranged from 3-55cms (mean = 22cms). Anteroposterior length showed a statistically significant positive association with retraction (P<.0001). There were 49 tendons without cuff delamination and 10 tendons with surgically confirmed delamination. Comparing the ratio of RCT length to retraction, tendons without delamination (1.2:1) showed significantly less retraction (P=.04) than tendons with delamination (1:1.1).

In full-thickness RCTs, anteroposterior length correlates closely with tendon retraction and approximates a 1:1 relationship. When the anteroposterior length measures less than the greatest degree of tendon retraction (ratio less than 1:1), the supraspinatus tendon should be scrutinized for possible cuff delamination. Cuff delamination is important to recognize because it is associated with a poorer surgical outcome.

Venkatesan, A, Fritz, B, Kassarjian, A, Palmer, W, Correlation between the Size of Rotator Cuff Tear and the Degree of Tendon Retraction.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4420442.html