Geometric ClassificationRotator Cuff Tears

James Davidson, MD Steve Burkhart, MD Phoenix San Antonio

Goals of a Classification System Communicate Treatment Prognosis Comparison

Previous Classifications Do not achieve these goals No current Standard Do not utilize three dimension info derived

from MRI and Arthroscopy

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. TransverseB. LongitudinalC. Retracted

McLaughlin Not widely adopted Pre MRI Pre Arthroscopy

DeOrio and CofieldMeasure the Maximum Single Diameter

Small, Medium, Large, Massive

DeOrio and Cofield Not geometric or three dimensional

Harryman / Gerber Number of tendons torn

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

Geometric ClassificationRotator 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

Geometric ClassificationType 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 Excellent3 Massive Contracted Long and Wide Interval slides/

Partial repair Fair to Good

4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty

Variable

Crescent Short and Wide; Length ≤ Width

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

Crescent MRI

Crescent Repaired end to bone Good to excellent results

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

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

Longitudinal MRI

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

Longitudinal (U’s and L’s)

Massive Contracted Long and wide

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

Massive Contracted MRI

Massive Contracted

Slides / Partial repair Fair to good results

Massive Contracted

L ≥ 2cm; W ≥ 2cm most require slides/partial L ≥ 3cm; W ≥ 3cm all require slides/partial

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

Additional NotationsRelated Pathology

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 ClassificationType 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 Excellent3 Massive Contracted Long and Wide Interval slides/

Partial repair Fair to Good

4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty

Variable

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

Geometric Classification

Thank You

James Davidson, MD Steve Burkhart, MD