Risk factors of radiographic severity of massive rotator cuff tear

Abstract

As massive rotator cuff tears progress, various radiographic changes occur; however, the factors associated with radiographic changes remain largely unknown. This study aimed to determine the factors that affect radiographic severity in massive rotator cuff tears using multivariate analyses. We retrospectively reviewed 210 shoulders with chronic massive rotator cuff tears. The dependent variables were superior migration of the humeral head (Hamada grades 2-3), narrowing of the glenohumeral joint (grade 4), and humeral head collapse (grade 5). Baseline variables that were significant in univariate analyses were included in multivariate models. There were 91, 59, 43, and 17 shoulders classified as Hamada grades 1, 2-3, 4, and 5, respectively. Multivariate analysis showed that infraspinatus tear (P = 0.015) and long head of biceps (LHB) tendon rupture (P = 0.007) were associated with superior migration of humeral head. Superior subscapularis tear (P = 0.003) and LHB tendon rupture (P < 0.001) were associated with narrowing of glenohumeral joint. Female sex (P = 0.006) and superior subscapularis tear (P = 0.006) were associated with humeral head collapse. This study identified the rupture of infraspinatus and LHB as risk factors of superior migration of humeral head, and the rupture of subscapularis and LHB and female sex as risk factors of cuff tear arthropathy.

Figure 1

Radiographic images showing different grades of the Hamada classification of massive rotator cuff tears. (A) Grade 1 is characterized by a maintained acromiohumeral interval. (B) Grade 2 shows narrowing of the acromiohumeral interval. (C) Grade 3 shows subacromial acetabulization in addition to grade 2 features. (D) Grade 4 shows narrowing of the glenohumeral joint in addition to grade 3 features. (E) Grade 5 indicates humeral head collapse.

Figure 2

The graphs indicate the proportion of the involved tendon of the rotator cuff in Hamada grades 1, 2,3, 4, and 5. SSC subscapularis, SSP supraspinatus, ISP infraspinatus, TM teres minor.