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Upper Limb: T. J. W. Matthews, G. C. Hand, J. L. Rees, N. A. Athanasou, and A. J. Carr Pathology of the torn rotator cuff tendon: REDUCTION IN POTENTIAL FOR REPAIR AS TEAR SIZE INCREASES J Bone Joint Surg Br 2006; 88-B: 489-495 [Abstract] [Full text] [PDF]

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Pathology of the torn rotator cuff

Quamar Bismil, Neil Ferguson, David M. Ricketts   (20 April 2006)

Pathology of the torn rotator cuff 20 April 2006
Quamar Bismil, Specialist Registrar in Orthopaedics and Trauma South-West Thames, Neil Ferguson, David M. Ricketts Send letter to journal: Re: Pathology of the torn rotator cuff quamar.bismil{at}btinternet.com Quamar Bismil, et al.	Sir, We read this article with interest in which the authors describe the histological findings in rotator cuff tears. We would like to make the following points: 1. Matthews’ study addresses histological findings alone, and extrapolates the potential effect on rotator cuff repair. We feel other important factors influence the success of rotator cuff repair and deserve mention: surgeon factors including surgical technique, post-operative rehabilitation protocol, inadequate mobilisation of rotator cuff tissue, deltoid detachment or denervation; and patient factors such as tissue quality, the presence of a chronic rupture of the long head of the biceps tendon, the degree of pre-operative shoulder weakness, concurrent acromioclavicular arthritis, and poor rotator cuff healing.1 2. In the ‘implications for surgical practice’ section of the paper, the authors state that "uncertainty also surrounds the role of external mechanical forces (impingement) in the onset and progression of the degenerative change shown in this study." A review of the literature highlights the multifactorial aetiology of rotator cuff tears, including impingement,2 ageing,3 vascularity,3 trauma3 and genetics.4 3. The concluding sentence states that the findings of this histological study "have ramifications for patient selection for an anticipated successful repair of the rotator cuff and raise questions about the use of…subacromial decompression." The literature consistently highlights the utility of subacromial decompression in cuff rupture: alone and combined with cuff repair.1 Matthews’ paper does not present any data to add to or detract from this evidence base. Q. Bismil, Specialist Registrar, N. Ferguson, Senior House Officer, Orthopaedics and Trauma, D.M. Ricketts, Consultant Orthopaedic Surgeon, The Princess Royal Hospital, Haywards Heath, UK. 1. Iannotti JP. Full-Thickness Rotator Cuff Tears: Factors Affecting Surgical Outcome. J Am Acad Ortho Surg 1994;2:87-95. 2. Richards DP, Burkhart SS, Campbell SE. Relation between narrowed coracohumeral distance and subscapularis tears. Arthroscopy 2005;21:1223-8. 3. Azar FM. Shoulder and Elbow Injuries. In Campbell’s Operative Orthopaedics Tenth Edition. Canale ST (ed). Mosby, Philadelphia, 2003. 4. Harvie P, Ostlere SJ, Teh J, et al. Genetic influences in the aetiology of tears of the rotator cuff. Sibling risk of a full-thickness tear. J Bone Joint Surg [Br] 2004;86-B:696-700.