Presentation on theme: "Geometric Classification Rotator Cuff Tears"— Presentation transcript:
1 Geometric Classification Rotator Cuff Tears James Davidson, MD Steve Burkhart, MDPhoenix San Antonio
2 Goals of a Classification System CommunicateTreatmentPrognosisComparison
3 Previous Classifications Do not achieve these goalsNo current StandardDo not utilize three dimension info derived from MRI and Arthroscopy
4 McLaughlin Transverse Longitudinal Retracted LESIONS OF THE MUSCULOTENDINOUS CUFF OF THE SHOULDERBY 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 UniversityTHE JOURNAL OF BONE AND JOINT SURGERY JANUARY 1944Dr.
9 Harryman / Gerber Not geometric or three dimensional ?? treatment ?? prognosis
10 Geometric Classification Rotator Cuff Tears A System Linking Tear PatterntoTreatment and PrognosisArthroscopy Current Concepts In Press, 2009
11 Foundation Burkhart, Adams, Arrigoni, Barth, Brady, Huberty, Lo, Parten, Pearce, Richards,Tehrani, Tauro, and others
12 Geometric Classification TypeDescriptionPreoperative MRITreatmentPrognosis1CrescentShort - Wide TearEnd to boneGood to Excellent2Longitudinal (L or U)Long –Narrow TearSide to Side3Massive ContractedLong and WideInterval slides/Partial repairFair to Good4Cuff Tear ArthropathyLoss of AHI, DJDIrreparableArthroplastyVariable
25 Massive ContractedSlides / Partial repairFair 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 InterspaceGlenohumeral ArthrosisIrreparable by Scope or OpenArthroplasty if Surgery
28 Additional Notations Related Pathology SubscapularisBicepsLabrumInstabilityArthritis AC or GHFatty Degeneration
29 MRI Predicts Tear Pattern CrescentLongitudinalMassive ContractedCases 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 TypeDescriptionPreoperative MRITreatmentPrognosis1CrescentShort - Wide TearEnd to boneGood to Excellent2Longitudinal (L or U)Long –Narrow TearSide to Side3Massive ContractedLong and WideInterval slides/Partial repairFair to Good4Cuff Tear ArthropathyLoss of AHI, DJDIrreparableArthroplastyVariable
32 Geometric Classification Improved CommunicationGuidance re TreatmentGuidance re PrognosisMeaningful Comparison
33 Geometric Classification Thank YouJames Davidson, MD Steve Burkhart, MD