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Geometric Classification Rotator Cuff Tears

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.

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Geometric Classification Rotator Cuff Tears

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  1. Geometric ClassificationRotator Cuff Tears James Davidson, MD Steve Burkhart, MD Phoenix San Antonio

  2. Goals of a Classification System • Communicate • Treatment • Prognosis • Comparison

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

  4. McLaughlin Transverse Longitudinal Retracted

  5. McLaughlin • Not widely adopted • Pre MRI • Pre Arthroscopy

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

  7. DeOrio and Cofield • Not geometric or three dimensional

  8. Harryman / Gerber • Number of tendons torn

  9. Harryman / Gerber • Not geometric or three dimensional • ?? treatment • ?? prognosis

  10. Geometric ClassificationRotator Cuff Tears A System Linking Tear Pattern to Treatment and Prognosis Arthroscopy Current Concepts In Press, 2009

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

  12. Geometric Classification

  13. Crescent • Short and Wide; Length ≤ Width

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

  15. Crescent MRI

  16. Crescent • Repaired end to bone • Good to excellent results

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

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

  19. Longitudinal MRI

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

  21. Longitudinal (U’s and L’s)

  22. Massive Contracted • Long and wide

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

  24. Massive Contracted MRI

  25. Massive Contracted • Slides / Partial repair • Fair to good results

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

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

  28. Additional NotationsRelated Pathology • Subscapularis • Biceps • Labrum • Instability • Arthritis AC or GH • Fatty Degeneration

  29. MRI Predicts Tear Pattern Crescent Longitudinal Massive Contracted

  30. Tear Pattern Determines Method of Repair and Prognosis

  31. Geometric Classification

  32. Geometric Classification • Improved Communication • Guidance re Treatment • Guidance re Prognosis • Meaningful Comparison

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

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