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Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 1, 119-123.
doi: 10.1302/0301-620X.91B1.21058  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
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The morphological and immunocytochemical features of impingement syndrome and partial-thickness rotator-cuff tear in relation to outcome after subacromial decompression

R. T. Benson, MRCS, Specialist Registrar1; S. M. McDonnell, MRCS, Specialist Registrar1; J. L. Rees, MD, FRCS(Orth), University Lecturer1; N. A. Athanasou, PhD, FRCPath, Professor of Osteoarticular Pathology1; and A. J. Carr, ChM, FRCS, Nuffield Professor of Orthopaedic Surgery1

1 Nuffield Department of Orthopaedic Surgery, Botnar Research Centre, Oxford University Institute of Musculoskeletal Sciences, Oxford OX3 7LD, UK.

Correspondence should be sent to Professor A. J. Carr; e-mail: Andrew.Carr{at}ndos.ox.ac.uk

We assessed the predictive value of the macroscopic and detailed microscopic appearance of the coracoacromial ligament, subacromial bursa and rotator-cuff tendon in 20 patients undergoing subacromial decompression for impingement in the absence of full-thickness tears of the rotator cuff. Histologically, all specimens had features of degenerative change and oedema in the extracellular matrix. Inflammatory cells were seen, but there was no evidence of chronic inflammation. However, the outcome was not related to cell counts.

At three months the mean Oxford shoulder score had improved from 29.2 (20 to 40) to 39.4 (28 to 48) (p < 0.0001) and at six months to 45.5 (36 to 48) (p < 0.0001). At six months, although all patients had improved, the seven patients with a hooked acromion had done so to a less extent than those with a flat or curved acromion judged by their mean Oxford shoulder scores of 43.5 and 46.5 respectively (p = 0.046). All five patients with partial-thickness tears were within this group and demonstrated less improvement than the patients with no tear (mean Oxford shoulder scores 43.2 and 46.4, respectively, p = 0.04). These findings imply that in the presence of a partial-thickness tear subacromial decompression may require additional specific treatment to the rotator cuff if the outcome is to be improved further.






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