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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 7, 893-898.
doi: 10.1302/0301-620X.90B7.19918  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Measurement of blood flow in the rotator cuff using laser Doppler flowmetry

O. Levy, MD, MCh(Orth), Professor, Orthopaedic Surgeon1; J. Relwani, FRCS (Tr & Orth), Shoulder Fellow1; T. Zaman, FRCS (Tr & Orth), Shoulder Fellow1; T. Even, MD MSC (Stats), Medical Statistician1; B. Venkateswaran, FRCS (Tr & Orth), Shoulder Fellow1; and S. Copeland, FRCS, Consultant Orthopaedic Surgeon1

1 Reading Shoulder Unit, Royal Berkshire Hospital, Reading RG1 5AN, UK.

Correspondence should be sent to Professor O. Levy; e-mail: oferlevy{at}readingshoulderunit.com

The aim of this study was to define the microcirculation of the normal rotator cuff during arthroscopic surgery and investigate whether it is altered in diseased cuff tissue.

Blood flow was measured intra-operatively by laser Doppler flowmetry. We investigated six different zones of each rotator cuff during the arthroscopic examination of 56 consecutive patients undergoing investigation for impingement, cuff tears or instability; there were 336 measurements overall.

The mean laser Doppler flowmetry flux was significantly higher at the edges of the tear in torn cuffs (43.1, 95% confidence interval (CI) 37.8 to 48.4) compared with normal cuffs (32.8, 95% CI 27.4 to 38.1; p = 0.0089). It was significantly lower across all anatomical locations in cuffs with impingement (25.4, 95% CI 22.4 to 28.5) compared with normal cuffs (p = 0.0196), and significantly lower in cuffs with impingement compared with torn cuffs (p < 0.0001).

Laser Doppler flowmetry analysis of the rotator cuff blood supply indicated a significant difference between the vascularity of the normal and the pathological rotator cuff. We were unable to demonstrate a functional hypoperfusion area or so-called ‘critical zone’ in the normal cuff. The measured flux decreases with advancing impingement, but there is a substantial increase at the edges of rotator cuff tears. This might reflect an attempt at repair.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General