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