Geometric Classification Rotator Cuff Tears James Davidson, MD Steve Burkhart, MD Phoenix San Antonio

Goals of a Classification System Communicate Treatment Prognosis Comparison

Previous Classifications Do not achieve these goals No current Standard Do not utilize three dimension info derived from MRI and Arthroscopy

McLaughlin Transverse Longitudinal Retracted LESIONS OF THE MUSCULOTENDINOUS CUFF OF THE SHOULDER BY HARRISON L. McLAUGHLIN, M.D., NEW YORK, N. Y. From the Fracture Service of the Presbyterian Hospital in New York, and the Department of Surgery, the College of Physicians and Surgeons, Columbia University THE JOURNAL OF BONE AND JOINT SURGERY JANUARY 1944 Dr.

McLaughlin Not widely adopted Pre MRI Pre Arthroscopy

DeOrio and Cofield Measure the Maximum Single Diameter Small, Medium, Large, Massive

DeOrio and Cofield Not geometric or three dimensional

Harryman / Gerber Number of tendons torn

Harryman / Gerber Not geometric or three dimensional ?? treatment ?? prognosis

Geometric Classification Rotator Cuff Tears A System Linking Tear Pattern to Treatment and Prognosis Arthroscopy Current Concepts In Press, 2009

Foundation Burkhart, Adams, Arrigoni, Barth, Brady, Huberty, Lo, Parten, Pearce, Richards, Tehrani, Tauro, and others

Geometric Classification Type Description Preoperative MRI Treatment Prognosis 1 Crescent Short - Wide Tear End to bone Good to Excellent 2 Longitudinal (L or U) Long –Narrow Tear Side to Side 3 Massive Contracted Long and Wide Interval slides/ Partial repair Fair to Good 4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty Variable

Crescent Short and Wide; Length ≤ Width

Crescent MRI Length: T2 coronal Width: T2 sagittal L ≤ W; L < 2cm

Crescent MRI

Crescent Repaired end to bone Good to excellent results

Longitudinal (U’s and L’s) Long and Narrow; Length > Width

Longitudinal MRI Length: T2 coronal Width: T2 sagittal L > W; W < 2cm

Longitudinal MRI

Longitudinal (U’s and L’s) Repaired side to side / margin convergence Good to excellent results

Longitudinal (U’s and L’s)

Massive Contracted Long and wide

Massive Contracted MRI Length: T2 coronal Width: T2 sagittal L ≥ 2cm; W ≥ 2cm

Massive Contracted MRI

Massive Contracted Slides / Partial repair Fair to good results

Massive Contracted L ≥ 2cm; W ≥ 2cm most require slides/partial L ≥ 3cm; W ≥ 3cm all require slides/partial

Rotator Cuff Arthropathy Loss of Acromiohumeral Interspace Glenohumeral Arthrosis Irreparable by Scope or Open Arthroplasty if Surgery

Additional Notations Related Pathology Subscapularis Biceps Labrum Instability Arthritis AC or GH Fatty Degeneration

MRI Predicts Tear Pattern Crescent Longitudinal Massive Contracted Cases were divided into three groups. Group one included all cases in which the MRI showed a coronal length less than the sagittal width and a length less than 2 cm. Group two included all cases in which the MRI showed a length greater than the width and a width less than 2 cm. Group three included all cases in which the MRI showed a length and width both greater than 2 cm.

Tear Pattern Determines Method of Repair and Prognosis So we see that tear shape and size determine repair technique. It would be helpful if the MRI could preoperatively show us the tear pattern and help us plan how to fix it.

Geometric Classification Type Description Preoperative MRI Treatment Prognosis 1 Crescent Short - Wide Tear End to bone Good to Excellent 2 Longitudinal (L or U) Long –Narrow Tear Side to Side 3 Massive Contracted Long and Wide Interval slides/ Partial repair Fair to Good 4 Cuff Tear Arthropathy Loss of AHI, DJD Irreparable Arthroplasty Variable

Geometric Classification Improved Communication Guidance re Treatment Guidance re Prognosis Meaningful Comparison

Geometric Classification Thank You James Davidson, MD Steve Burkhart, MD