Does tear origin associate with tendon delamination in degenerative full thickness rotator cuff tears?

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Musculoskeletal Research

Background:

• Rotator cuff delamination involves horizontal tears between bursal and articular surfaces.
• The origin of delamination (articular vs. bursal side) in degenerative tears remains debated.
• This study investigates the relationship between tear origin and delamination in full-thickness rotator cuff tears.

Purpose of the Study:

• To evaluate the association between tear origin and delamination in degenerative full-thickness rotator cuff tears.
• To identify risk factors contributing to rotator cuff delamination.

Main Methods:

• Retrospective case series of 66 patients undergoing shoulder arthroscopy for small- to medium-sized degenerative full-thickness rotator cuff tears (2020-2024).
• Patients were grouped based on the presence or absence of delamination.
• Tear initiation side was assessed using coracoacromial ligament (CAL) degeneration grade, capsular remnants, and acromioclavicular joint osteophytes; regression analysis identified risk factors.

Main Results:

• Delamination was significantly more frequent in tears with Grade 2-3 CAL degeneration (79% vs. 29%), capsular remnants (75% vs. 32%), and acromioclavicular joint osteophytes (43% vs. 19%).
• Regression analysis identified Grade 2-3 CAL degeneration (OR=5.669) and capsular remnants (OR=3.832) as significant risk factors for delamination.
• No significant differences were noted in age, sex, dominant extremity, symptom duration, or tear retraction between groups.

Conclusions:

• Bursal-sided tear initiation appears associated with delamination in degenerative full-thickness rotator cuff tears.
• Careful evaluation for delamination via the lateral viewing portal is recommended when bursal-sided origin is suspected.
• Surgical planning should consider the potential presence of delamination based on tear origin indicators.