Factors Influencing the Reparability and Healing Rates of Rotator Cuff Tears

Abstract

Purpose of the review: To discuss tear- and patient-related factors that influence the healing potential of rotator cuff tears and to clarify the terminology surrounding this topic.

Recent findings: Over the last few years, further insight has been gained regarding rotator cuff tear features that are associated with poor healing rates after rotator cuff repair. Some of these features have been incorporated in prediction models developed to accurately predict rotator cuff healing rates utilizing preoperative risk factors weighted by importance. Rotator cuff tears may be considered functionally irreparable based on their size, chronicity, absence of adequate tendon length, atrophy, and fatty infiltration. Furthermore, advanced age, use of tobacco products, diabetes, and other patient-related factors may impair tendon healing. Careful analysis and discussion of all these factors with patients is essential to determine if surgical repair of a rotator cuff tear should be recommended, or if it is best to proceed with one of the several salvage procedures reviewed in this topical collection, including augmentation of the repair, superior capsular reconstruction, tendon transfers, and other.

Keywords: Factors; Irreparable; Non-healing; Re-tear; Rotator cuff; Rotator cuff repair.

Fig. 1

Collin classification of rotator cuff tear size. T2 MRI sagittal oblique images demonstrating the Collin classification of rotator cuff tear size. The rotator cuff is divided into five sections: lower subscapularis, upper subscapularis, supraspinatus, infraspinatus, and teres minor. The classification system consists of five rotator cuff tear types: type A involves upper subscapularis and supraspinatus; type B involves the entire subscapularis and supraspinatus; type C involves upper subscapularis, supraspinatus, and infraspinatus; type D involves supraspinatus and infraspinatus; and type E involves supraspinatus, infraspinatus, and teres minor

Fig. 2

Example of fatty degeneration on MRI. T1 MRI sagittal oblique image demonstrating moderate fatty degeneration of the supraspinatus and infraspinatus muscle bellies, according to the Fuchs-Gerber classification. Note that only fat (white) within the confines of the muscle parenchyma, as opposed to the fat surrounding the muscle belly, is considered true fatty degeneration

Fig. 3

Tangent lines used to evaluate for muscle atrophy. Tangent lines can be used to evaluate muscle atrophy in the setting of a rotator cuff tear. Lines are drawn between the coracoid tip and scapular spine (supraspinatus), the coracoid and the scapular tip (subscapularis), and scapular spine and scapular tip (infraspinatus and teres minor) on sagittal oblique images. A positive tangent sign is present when the respective muscle bellies do not cross their tangent line. “Used with permission of Mayo Foundation for Medical Education and Research. All rights reserved”

Fig. 4

Tendon delamination may correlate with decreased chance of tendon healing arthroscopic images from lateral viewing portal demonstrating delamination of the supraspinatus tendon

Fig. 5

Measurement of residual tendon length. T2 MRI coronal oblique image demonstrating decreased supraspinatus tendon length in the setting of a rotator cuff tear. Note that tendon retraction in and of itself will cause muscle belly cross-sectional area to appear decreased, regardless of the presence of true muscle atrophy, due to the fusiform nature of supraspinatus