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. 2021 Mar 22;9(3):2325967121990423.
doi: 10.1177/2325967121990423. eCollection 2021 Mar.

Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

Hyungsuk Kim  1 , Chu Hwan Byun  1 , Sung Bin Han  1 , Hyun Seok Song  1
Affiliations

Surgical Treatment Outcomes for Everted Bursal Flap of Delaminated Supraspinatus Tear

Hyungsuk Kim et al. Orthop J Sports Med. .

Abstract

Background: Although everted bursal flaps of delaminated tears have been reported, few studies have reported radiologic images, arthroscopic findings, and clinical results after repair.

Purpose: To compare the repair outcomes of everted delaminated tears with those of classic delaminated supraspinatus tears.

Study design: Cohort study; Level of evidence, 3.

Methods: Among 153 patients who underwent arthroscopic rotator cuff repair for a delaminated supraspinatus tear, everted bursal flap tears were observed in 24 patients upon arthroscopy (group A). Another 24 patients with classic delaminated supraspinatus tears, matched for age and sex, were selected for group B. Magnetic resonance imaging (MRI) and ultrasonography were performed preoperatively and postoperatively. Patients were evaluated using a visual analog scale (VAS) for pain as well as functional scores (American Shoulder and Elbow Surgeons [ASES] score, Constant score, and University of California Los Angeles shoulder score). Scores were compared preoperatively and at final follow-up (mean follow-up, 32 months).

Results: Patients in both groups A and B reported improved VAS and functional scores at the final follow-up. In group A, preoperative VAS scores were higher and functional scores were poorer than in group B. Subacromial effusions with tendon swelling on preoperative MRI were more common in group A. During follow-up ultrasonography, group A patients exhibited persistent subacromial effusion. However, VAS scores at final follow-up were significantly better in group A (0.4 ± 0.7) than in group B (1.6 ± 1.4) (P < .001), and ASES scores at final follow-up were better in group A (84.3 ± 4.3) than in group B (77.0 ± 10.2) (P = .005).

Conclusion: Everted bursal flap delaminated tears were associated with higher VAS scores and poorer functional scores preoperatively. Although subacromial effusions were experienced by group A during the early postoperative period, clinical outcomes at final follow-up were significantly better for everted delaminated tears compared with classic delaminated tears.

Keywords: arthroscopy; broccoli-like; delamination; everted; supraspinatus.

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Conflict of interest statement

The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
(A) Magnetic resonance image of the left shoulder of a 65-year-old woman showing a subacromial effusion (arrow) extending into the subdeltoid space and the thickened torn edge (arrowheads) of an everted bursal flap tear. (B) Arthroscopic image showing the torn surface (arrowheads) of the everted bursal flap tear.
Figure 2.
Figure 2.
(A) Magnetic resonance image of the right shoulder of a 52-year-old woman showing how the thickness of the medial torn edge (arrow heads) of an everted bursal flap tear is measured (arrow). See the online Supplemental Video showing the everted bursal flap of delaminated tear in this patient. (B) Arthroscopic image showing the torn surface (arrowheads) of the everted bursal flap tear. (C) Arthroscopic image showing the reduced bursal flap (arrowheads) to the footprint.
Figure 3.
Figure 3.
Arthroscopic image of the left shoulder of a 56-year-old man showing a broccoli head–like torn surface (black arrow) of the supraspinatus tendon.
Figure 4.
Figure 4.
Serial follow-up MRI scans of the right shoulder of a 58-year-old woman. (A) Preoperative MRI scan taken at 10 months earlier showing a mild grade partial-thickness tear (arrow). (B) Preoperative MRI scan taken on the day before surgery showing a progressed everted tear (arrow). (C) Arthroscopic image showing the everted bursal flap of the supraspinatus (arrow). (D) MRI scan taken at 10 months postoperatively showing little subacromial effusion over the repaired tendon.
See this image and copyright information in PMC

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