CLINICAL, PARACLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF LARGE ROTATOR CUFF TEARS
Main Article Content
Abstract
Objective: To evaluate the clinical characteristics, imaging findings, and morphological patterns of large rotator cuff tears.
Materials and Methods: A descriptive study was conducted on 170 patients diagnosed with large rotator cuff tears. Clinical assessment included the Jobe test, Patte test, Gerber test, Drop Arm test, Visual Analog Scale (VAS), University of California at Los Angeles (UCLA) score, Constant score, and shoulder range of motion measurements. Imaging evaluation was performed using plain radiography and magnetic resonance imaging (MRI) to assess the Hamada classification, tendon retraction according to Patte, fatty infiltration of the rotator cuff muscles, tear size, and tear morphology based on the Collin and Ellman classifications.
Results: The mean age of the patients was 61.94 ± 7.76 years, with degenerative etiology accounting for 74.12% of cases. Preoperative mean VAS score was 8.91 ± 0.75, UCLA score was 11.72 ± 2.27, and Constant score was 31.75 ± 3.84, indicating substantial impairment of shoulder function. Positive clinical test rates were 100% for the Jobe test, 90.6% for the Patte test, 30.0% for the Gerber test, and 28.8% for the Drop Arm test. Imaging findings showed Patte grade III tendon retraction in 68.8% of patients, Hamada grade II in 75.9%, and Goutallier grade II fatty infiltration in 57.6%. According to the Collin classification, type C tears were the most common (72.4%). Trapezoidal tear morphology accounted for 51.76% of cases. The mean tear dimensions were 31.77 mm in the anterior–posterior direction and 34.57 mm in the medial–lateral direction.
Conclusions: Large rotator cuff tears are commonly observed in middle-aged and elderly patients and are characterized by severe shoulder pain and marked functional impairment. Typical features include advanced tendon retraction, fatty muscle infiltration, and complex tear patterns, with Collin type C and trapezoidal tears being the predominant forms. Comprehensive clinical and imaging evaluation plays a crucial role in surgical planning and prognostic assessment.
Keywords
Large rotator cuff tear, fatty infiltration, tendon retraction.
Article Details
References
2. Gerber, C., Fuchs, B. & Hodler, J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82, 505–515 (2000).
3. Burkhart, S. S., Danaceau, S. M. & Pearce, C. E. Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy 17, 905–912 (2001).
4. Collin, P., Matsumura, N., Lädermann, A., Denard, P. J. & Walch, G. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg 23, 1195–1202 (2014).
5. Zumstein, M.-A., Lädermann, A., Raniga, S. & Schär, M.-O. The biology of rotator cuff healing. Orthop Traumatol Surg Res 103, S1–S10 (2017).
6. Hamada, K., Fukuda, H., Mikasa, M. & Kobayashi, Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 92–96 (1990).
7. The biology of rotator cuff healing - PubMed. https://pubmed.ncbi.nlm.nih.gov/28043853/.
8. Goutallier, D., Postel, J. M., Bernageau, J., Lavau, L. & Voisin, M. C. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 78–83 (1994).
9. Gladstone, J. N., Bishop, J. Y., Lo, I. K. Y. & Flatow, E. L. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35, 719–728 (2007).