Are there differences in arthroscopic and histological features between traumatic and degenerative rotator cuff tears in elderly patients? A prospective dual-center analysis

Abstract

Background: Discriminating traumatic rotator cuff tears (RCTs) from degenerative RCTs is sometimes difficult in elderly patients because the prevalence of asymptomatic RCTs increases with age. Little intraoperative information is available on the characteristics of traumatic and degenerative RCTs in elderly patients. The purpose of this study was to compare the arthroscopic findings and histological changes of the coracoacromial ligament (CAL) between traumatic and degenerative RCTs in elderly patients.

Methods: Forty-two shoulders of 42 patients aged ≥ 65 years underwent arthroscopic rotator cuff repair. Nineteen patients had traumatic full-thickness RCTs (Group T), and 23 had degenerative full-thickness RCTs (Group D). The quality of the rotator cuff tissue and the condition of the long head of the biceps were examined. The grade of CAL was evaluated both arthroscopically and histologically. The stiffness of the musculotendinous unit was calculated by measuring the force and displacement using a tensiometer. The arthroscopic and histological findings of the two groups were compared.

Results: Although the mean tendon displacement was comparable, the stiffness was different between Group T and Group D (0.56 ± 0.31 and 1.09 ± 0.67 N/mm, respectively; p < 0.001). Both arthroscopic and histological analysis of the CAL showed that the degenerative changes in the CAL were milder in Group T than in Group D (p < 0.001 and p < 0.001, respectively). There was a moderate positive correlation between the arthroscopic findings of CAL degeneration and the histopathological changes in this ligament (r = 0.47, p = 0.002).

Conclusions: Traumatic RCTs were characterized by preserved elasticity of the musculotendinous unit and milder CAL degeneration compared with degenerative RCTs even in elderly patients.

Keywords: Arthroscopy; Coracoacromial ligament; Elderly; Histology; Repair tension; Traumatic rotator cuff tears.

Fig. 1

a Observation from the posterolateral portal of the right shoulder. Grade 2 coracoacromial ligament degeneration was confirmed. b The acromion and the coracoacromial ligaments were removed using a chisel

Fig. 2

Measurement of the torn rotator cuff tension. A nonabsorbable suture that grasped the end of the tendon was pulled through the anterolateral portal and then tied to make a closed loop. This suture loop was connected to the sterile hook of a digital tensiometer. Tension was forced to the tensiometer until full coverage of the footprint was attained

Fig. 3

a Type I: Fissuring of the collagenous fiber layer with no abnormal changes in the other three layers. The coracoacromial ligament attachment at the undersurface of the acromion was composed of four layers: collagenous fiber (C), fibrocartilage (FC), mineralized fibrocartilage (MF), and bone (B) (× 100). b Type II: Reactive changes such as enlargement of the fibrocartilage layer. Irregularity of the tidemark was observed (× 100). c Type III: Disappearance of the collagenous fiber layer and remaining hypertrophic changes in the fibrocartilage layer (× 100). d Type IV: Disappearance of the fibrocartilage layer, resulting in exposure of the osseous layer (× 100)