Presentation is loading. Please wait.

Presentation is loading. Please wait.

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

Similar presentations


Presentation on theme: "Geometric Classification Rotator Cuff Tears James Davidson, MD Steve Burkhart, MD Phoenix San Antonio."— Presentation transcript:

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 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. Transverse B. Longitudinal C. Retracted

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 Good to Excellent 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

30 Tear Pattern Determines Method of Repair and Prognosis

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 Good to Excellent 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


Download ppt "Geometric Classification Rotator Cuff Tears James Davidson, MD Steve Burkhart, MD Phoenix San Antonio."

Similar presentations


Ads by Google