Transcript Geometric Classification of Rotator Cuff Tears

Geometric Classification
Rotator Cuff Tears
James Davidson, MD
Phoenix
Steve Burkhart, MD
San Antonio
Goals of a Classification System
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Communicate
Treatment
Prognosis
Comparison
Previous Classifications
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Do not achieve these goals
No current Standard
Do not utilize three dimension info derived
from MRI and Arthroscopy
McLaughlin
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B.
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Transverse
Longitudinal
Retracted
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
Dr.
JANUARY 1944
McLaughlin
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Not widely adopted
Pre MRI
Pre Arthroscopy
DeOrio and Cofield
Measure the Maximum Single Diameter
Small, Medium, Large, Massive
DeOrio and Cofield
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Not geometric or three dimensional
Harryman / Gerber
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Number of tendons torn
Harryman / Gerber
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Not geometric or three dimensional
?? treatment
?? prognosis
Geometric Classification
Rotator Cuff Tears
A System Linking Tear Pattern
to
Treatment and Prognosis
Arthroscopy
Current Concepts
In Press, 2009
Foundation
Burkhart, Adams, Arrigoni, Barth, Brady,
Huberty, Lo, Parten, Pearce, Richards,
Tehrani, Tauro, and others
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Geometric Classification
Type Description
Preoperative MRI
Treatment
Prognosis
1
Crescent
Short - Wide Tear
End to bone
Good to Excellent
2
3
Longitudinal (L or U)
Massive Contracted
Long –Narrow Tear
Long and Wide
Good to Excellent
Fair to Good
4
Cuff Tear Arthropathy
Loss of AHI, DJD
Side to Side
Interval slides/
Partial repair
Irreparable
Arthroplasty
Variable
Crescent
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Short and Wide; Length ≤ Width
Crescent MRI
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Length: T2 coronal
Width: T2 sagittal
L ≤ W; L < 2cm
Crescent MRI
Crescent
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Repaired end to bone
Good to excellent results
Longitudinal (U’s and L’s)
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Long and Narrow; Length > Width
Longitudinal MRI
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Length: T2 coronal
Width: T2 sagittal
L > W; W < 2cm
Longitudinal MRI
Longitudinal (U’s and L’s)
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Repaired side to side / margin convergence
Good to excellent results
Longitudinal (U’s and L’s)
Massive Contracted
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Long and wide
Massive Contracted MRI
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Length: T2 coronal
Width: T2 sagittal
L ≥ 2cm; W ≥ 2cm
Massive Contracted MRI
Massive Contracted
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Slides / Partial repair
Fair to good results
Massive Contracted
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L ≥ 2cm; W ≥ 2cm most require slides/partial
L ≥ 3cm; W ≥ 3cm all require slides/partial
Rotator Cuff Arthropathy
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Loss of Acromiohumeral Interspace
Glenohumeral Arthrosis
Irreparable by Scope or Open
Arthroplasty if Surgery
Additional Notations
Related Pathology
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Subscapularis
Biceps
Labrum
Instability
Arthritis AC or GH
Fatty Degeneration
MRI Predicts Tear Pattern
Crescent
Longitudinal
Massive Contracted
Tear Pattern Determines
Method of Repair and Prognosis
Geometric Classification
Type Description
Preoperative MRI
Treatment
Prognosis
1
Crescent
Short - Wide Tear
End to bone
Good to Excellent
2
3
Longitudinal (L or U)
Massive Contracted
Long –Narrow Tear
Long and Wide
Good to Excellent
Fair to Good
4
Cuff Tear Arthropathy
Loss of AHI, DJD
Side to Side
Interval slides/
Partial repair
Irreparable
Arthroplasty
Variable
Geometric Classification
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Improved Communication
Guidance re Treatment
Guidance re Prognosis
Meaningful Comparison
Geometric Classification
Thank You
James Davidson, MD
Steve Burkhart, MD