Transcript
Page 1: Geometric Classification Rotator Cuff Tears

Geometric ClassificationRotator Cuff Tears

James Davidson, MD Steve Burkhart, MD Phoenix San Antonio

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Goals of a Classification System Communicate Treatment Prognosis Comparison

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Previous Classifications Do not achieve these goals No current Standard Do not utilize three dimension info derived

from MRI and Arthroscopy

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McLaughlin

LESIONS OF THE MUSCULOTENDINOUS CUFF OF THE SHOULDER BY HARRISON L. McLAUGHLIN, M.D., NEW YORK, N. Y.

From the Fracture Service of the Presbyterian Hospital in New York, and the Department of Surgery, the College of Physicians and Surgeons, Columbia University

THE JOURNAL OF BONE AND JOINT SURGERY JANUARY 1944

Dr.

A. TransverseB. LongitudinalC. Retracted

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McLaughlin Not widely adopted Pre MRI Pre Arthroscopy

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DeOrio and CofieldMeasure the Maximum Single Diameter

Small, Medium, Large, Massive

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DeOrio and Cofield Not geometric or three dimensional

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Harryman / Gerber Number of tendons torn

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Harryman / Gerber Not geometric or three dimensional ?? treatment ?? prognosis

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Geometric ClassificationRotator Cuff Tears

A System Linking Tear Pattern to

Treatment and Prognosis

Arthroscopy Current Concepts In Press, 2009

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Foundation Burkhart, Adams, Arrigoni, Barth, Brady,Huberty, Lo, Parten, Pearce, Richards, Tehrani, Tauro, and others

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Geometric ClassificationType Description Preoperative MRI Treatment Prognosis

1 Crescent Short - Wide Tear End to bone Good to Excellent

2 Longitudinal (L or U) Long –Narrow Tear Side to Side Good to Excellent3 Massive Contracted Long and Wide Interval slides/

Partial repair Fair to Good

4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty

Variable

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Crescent Short and Wide; Length ≤ Width

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Crescent MRI Length: T2 coronal Width: T2 sagittal L ≤ W; L < 2cm

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Crescent MRI

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Crescent Repaired end to bone Good to excellent results

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Longitudinal (U’s and L’s) Long and Narrow; Length > Width

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Longitudinal MRI Length: T2 coronal Width: T2 sagittal L > W; W < 2cm

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Longitudinal MRI

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Longitudinal (U’s and L’s) Repaired side to side / margin convergence Good to excellent results

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Longitudinal (U’s and L’s)

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Massive Contracted Long and wide

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Massive Contracted MRI Length: T2 coronal Width: T2 sagittal L ≥ 2cm; W ≥ 2cm

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Massive Contracted MRI

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Massive Contracted

Slides / Partial repair Fair to good results

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Massive Contracted

L ≥ 2cm; W ≥ 2cm most require slides/partial L ≥ 3cm; W ≥ 3cm all require slides/partial

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Rotator Cuff Arthropathy Loss of Acromiohumeral Interspace Glenohumeral Arthrosis Irreparable by Scope or Open Arthroplasty if Surgery

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Additional NotationsRelated Pathology

Subscapularis Biceps Labrum Instability Arthritis AC or GH Fatty Degeneration

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MRI Predicts Tear Pattern

Crescent

Longitudinal

Massive Contracted

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Tear Pattern Determines Method of Repair and Prognosis

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Geometric ClassificationType Description Preoperative MRI Treatment Prognosis

1 Crescent Short - Wide Tear End to bone Good to Excellent

2 Longitudinal (L or U) Long –Narrow Tear Side to Side Good to Excellent3 Massive Contracted Long and Wide Interval slides/

Partial repair Fair to Good

4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty

Variable

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Geometric Classification Improved Communication Guidance re Treatment Guidance re Prognosis Meaningful Comparison

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Geometric Classification

Thank You

James Davidson, MD Steve Burkhart, MD


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