geometric classification rotator cuff tears

Download Geometric Classification Rotator Cuff Tears

Post on 24-Feb-2016

144 views

Category:

Documents

0 download

Embed Size (px)

DESCRIPTION

Geometric Classification Rotator Cuff Tears. James Davidson, MD Steve Burkhart, MD Phoenix San Antonio. Goals of a Classification System. Communicate Treatment Prognosis Comparison. Previous Classifications. - PowerPoint PPT Presentation

TRANSCRIPT

Hills-Sachs Lesions

Geometric ClassificationRotator Cuff Tears

James Davidson, MD Steve Burkhart, MD Phoenix San Antonio1Goals of a Classification SystemCommunicateTreatmentPrognosisComparison

2Previous ClassificationsDo not achieve these goalsNo current StandardDo not utilize three dimension info derived from MRI and Arthroscopy3McLaughlinLESIONS 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. TransverseLongitudinalRetracted4McLaughlinNot widely adoptedPre MRIPre Arthroscopy5DeOrio and CofieldMeasure the Maximum Single Diameter

Small, Medium, Large, Massive

6DeOrio and CofieldNot geometric or three dimensional

7Harryman / GerberNumber of tendons torn

8Harryman / GerberNot geometric or three dimensional?? treatment ?? prognosis 9Geometric ClassificationRotator Cuff Tears A System Linking Tear Pattern to Treatment and Prognosis

Arthroscopy Current Concepts In Press, 2009

10FoundationBurkhart, Adams, Arrigoni, Barth, Brady,Huberty, Lo, Parten, Pearce, Richards, Tehrani, Tauro, and others

11Geometric ClassificationType Description Preoperative MRI Treatment Prognosis1 Crescent Short - Wide Tear End to bone Good to Excellent2 Longitudinal (L or U) Long Narrow Tear Side to Side Good to Excellent3 Massive Contracted Long and Wide Interval slides/ Partial repair Fair to Good4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty Variable12Crescent Short and Wide; Length Width

13Crescent MRILength: T2 coronalWidth: T2 sagittalL W; L < 2cm

14Crescent MRI

15Crescent Repaired end to boneGood to excellent results

16Longitudinal (Us and Ls)Long and Narrow; Length > Width

17Longitudinal MRILength: T2 coronalWidth: T2 sagittalL > W; W < 2cm

18Longitudinal MRI

19Longitudinal (Us and Ls)Repaired side to side / margin convergenceGood to excellent results

20Longitudinal (Us and Ls)

21Massive ContractedLong and wide

22Massive Contracted MRILength: T2 coronalWidth: T2 sagittalL 2cm; W 2cm

23Massive Contracted MRI

24Massive ContractedSlides / Partial repairFair to good results

25Massive ContractedL 2cm; W 2cm most require slides/partialL 3cm; W 3cm all require slides/partial

26Rotator Cuff ArthropathyLoss of Acromiohumeral InterspaceGlenohumeral ArthrosisIrreparable by Scope or OpenArthroplasty if Surgery

27Additional NotationsRelated PathologySubscapularisBicepsLabrumInstabilityArthritis AC or GHFatty Degeneration

28

MRI Predicts Tear Pattern

Crescent

Longitudinal

Massive Contracted

29 Cases were divided into three groups. Group one included all cases in which the MRI showed a coronal length less than the sagittal width and a length less than 2 cm. Group two included all cases in which the MRI showed a length greater than the width and a width less than 2 cm. Group three included all cases in which the MRI showed a length and width both greater than 2 cm.

Tear Pattern Determines Method of Repair and Prognosis

30So we see that tear shape and size determine repair technique. It would be helpful if the MRI could preoperatively show us the tear pattern and help us plan how to fix it.Geometric ClassificationType Description Preoperative MRI Treatment Prognosis1 Crescent Short - Wide Tear End to bone Good to Excellent2 Longitudinal (L or U) Long Narrow Tear Side to Side Good to Excellent3 Massive Contracted Long and Wide Interval slides/ Partial repair Fair to Good4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty Variable31Geometric ClassificationImproved CommunicationGuidance re TreatmentGuidance re PrognosisMeaningful Comparison

32Geometric Classification

Thank You

James Davidson, MD Steve Burkhart, MD33

Recommended

View more >