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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 4, 489-495.
doi: 10.1302/0301-620X.88B4.16845  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Pathology of the torn rotator cuff tendon

REDUCTION IN POTENTIAL FOR REPAIR AS TEAR SIZE INCREASES

T. J. W. Matthews, BSc, MRCS, Research Fellow1; G. C. Hand, FRCS(Tr & Orth), Research Fellow1; J. L. Rees, MD, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1; N. A. Athanasou, PhD, FRCPath, Professor of Musculoskeletal Pathology1; and A. J. Carr, MCh, FRCS, Nuffield Professor of Orthopaedic Surgery1

1 Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.

Correspondence should be sent to Mr T. J. W. Matthews; e-mail: tim.matthews{at}ndos.ox.ac.uk

We have studied cellular and vascular changes in different stages of full thickness tears of the rotator cuff. We examined biopsies from the supraspinatus tendon in 40 patients with chronic rotator cuff tears who were undergoing surgery and compared them with biopsies from four uninjured subscapularis tendons. Morphological and immunocytochemical methods using monoclonal antibodies directed against leucocytes, macrophages, mast cells, proliferative and vascular markers were used.

Histological changes indicative of repair and inflammation were most evident in small sized rotator cuff tears with increased fibroblast cellularity and intimal hyperplasia, together with increased expression of leucocyte and vascular markers. These reparative and inflammatory changes diminished as the size of the rotator cuff tear increased. Marked oedema and degeneration was seen in large and massive tears, which more often showed chondroid metaplasia and amyloid deposition. There was no association between the age of the patient and the duration of symptoms. In contrast, large and massive tears showed no increase in the number of inflammatory cells and blood vessels.

Small sized rotator cuff tears retained the greatest potential to heal, showing increased fibroblast cellularity, blood vessel proliferation and the presence of a significant inflammatory component. Tissue from large and massive tears is of such a degenerative nature that it may be a significant cause of re-rupture after surgical repair and could make healing improbable in this group.




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Pathology of the torn rotator cuff
Quamar Bismil, et al.
J Bone Joint Surg Br Online, 20 Apr 2006 [Full text]

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