1. Geometric Classification Rotator Cuff Tears
James Davidson, MD Steve Burkhart, MD
Phoenix San Antonio

2. Goals of a Classification System
Communicate
Treatment
Prognosis
Comparison

3. Previous Classifications
Do not achieve these goals
No current Standard
Do not utilize three dimension info derived from MRI and Arthroscopy

4. McLaughlin 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 JANUARY 1944
Dr.

5. McLaughlin
Not widely adopted
Pre MRI
Pre Arthroscopy

6. DeOrio and Cofield
Measure the Maximum Single Diameter Small, Medium, Large, Massive

7. DeOrio and Cofield
Not geometric or three dimensional

8. Harryman / Gerber
Number of tendons torn

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

10. Geometric Classification Rotator Cuff Tears
A System Linking Tear Pattern to
Treatment and Prognosis
Arthroscopy Current Concepts In Press, 2009

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

12. Geometric Classification
Type
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 3
Massive Contracted
Long and Wide
Interval slides/
Partial repair
Fair to Good 4
Cuff Tear Arthropathy
Loss of AHI, DJD
Irreparable
Arthroplasty
Variable

13. Crescent
Short and Wide; Length ≤ Width

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

15. Crescent MRI

16. Crescent
Repaired end to bone
Good to excellent results

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

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

19. Longitudinal MRI

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

21. Longitudinal (U’s and L’s)

22. Massive Contracted
Long and wide

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

24. Massive Contracted MRI

25. Massive Contracted
Slides / Partial repair
Fair to good results

26. Massive Contracted L ≥ 2cm; W ≥ 2cm most require slides/partial
L ≥ 3cm; W ≥ 3cm all require slides/partial

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

28. Additional Notations Related Pathology
Subscapularis
Biceps
Labrum
Instability
Arthritis AC or GH
Fatty Degeneration

29. MRI Predicts Tear Pattern
Crescent
Longitudinal
Massive Contracted
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.

30. Tear Pattern Determines Method of Repair and Prognosis
So 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.

31. Geometric Classification
Type
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 3
Massive Contracted
Long and Wide
Interval slides/
Partial repair
Fair to Good 4
Cuff Tear Arthropathy
Loss of AHI, DJD
Irreparable
Arthroplasty
Variable

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

33. Geometric Classification
Thank You
James Davidson, MD Steve Burkhart, MD