Arthroscopic classification of partialthickness rotator cuff tears according to Ellman [32

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The author stated that any tear, whether partial or complete, should be classified as Stage III (impingement according to Neer [97]). The following subclassification of Stage III is proposed to include both partialand full-thickness rotator cuff tears (Table 1).

The classification of partial-thickness tears (Fig. 9 [34]) indicates which surface is involved and grades the severity of the tear according to depth. The normal cuff is considered to be 10-12-mm thick.

■ A Grade 1 partial tear (less than 3-mm deep) is relatively minor, but definite disruption of then tendinous fibres can be identified. Superficial fraying of the articular capsule does not constitute a cuff tear.

■ Grade 2 lesions (3-6-mm deep) extend well into the substance of the cuff but do not exceed one-half of the thickness of the tendon.

■ Grade 3 lesions are more than 6 mm in depth are significant disruptions of more than one-half the substance of the cuff; continuity appears tenuous.

A small arthroscopic probe with a 3-mm bent arm or a suction shaver of known diameter can be used to measure the tear. In addition to depth, the base of the defect and its width should be measured. This information clearly defines the extent of the tear.

Table 1. Subclassification of stage-Ill rotator cuff tears

Location Grade

Partial-thickness tear(P)a

A. Articular surface 1: <3 mm deep

B. Bursal surface 2: 3-6 mm deep

C. Interstitial 3: >6 mm deep Full-thickness tear (F)

A. Supraspinatus 1: Small, <2 cm

B. Infraspinatus 2: Large, 2-4 cm

D. Subscapulars 4: Cuff arthropathy

Area of defect

Base of tearxmaximum retraction = mm2

Base of tearxmaximum retraction = cm2

a Torn muscle(s)

Partial Thickness Tear Rotator
Fig. 9. Ellman classification of partial-thickness rotator cuff tears

Full-thickness tears are described in the traditional fashion with minor variations. Designated grades can be substituted for the adjectives small and large. A fourth grade is added to include cuff arthropathy. As defined by Neer, this includes a massive tear articular irregularity with collapse of the humeral head, chronic synovitis and capsular laxity. Estimates of the total area of defect measured in square millimeters or centimeters are obtained by multiplying the length of the base of the tear by the distance of maximum retraction. Use of the classification defines the location and extent of rotator cuff lesions and facilitates comparison of findings among various studies.

5.4 Arthroscopic classification of rotator cuff lesions according to Snyder (the Southern California Orthopedic Institute (SCOI) rotator cuff classification system) [121]

The Southern California Orthopedic Institute rotator cuff classification system is a simple, descriptive scheme that uses letters and numbers to designate the pathologic conditions of the tendon. The capital letter indicates the side of the cuff where the tear is located: A for articular-side partial tears, B for bursal-side partial injuries, and C for complete-thickness or trans-tendon damage. The degree of tendon damage is classified using a numeric designation of 0 to 4.

Location of tears A Articular surface B Bursal surface

C Complete tear, connecting A and B sides Severity of tear (A and B partial tears)

0 Normal cuff, with smooth coverings of synovium and bursa

1 Minimal, superficial bursal or synovial irritation or slight capsular fraying in a small, localized area; usually < 1 cm

II Actually fraying and failure of some rotator cuff fibres in addition to synovial, bursal, or capsular injury; usually <2 cm

III More severe rotator cuff injury, including fraying and fragmentation of tendon fibres, often involving the whole surface of a cuff tendon (most often the supraspinatus); usually <3 cm

IV Very severe partial rotator cuff tear that usually contains, in addition to fraying and fragmentation of tendon tissue, a sizable flap tear and often encompasses more than a single tendon

(A partial articular supraspinatus tendon avulsion (PASTA) is an A-III or A-IV tear.)

Classification of complete (C) rotator cuff tears

CI A small, complete tear, such as a puncture wound

CII A moderate tear (usually <2 cm) that still encompasses only one of the rotator cuff tendons with no retraction of the torn ends

CIII A large, complete tear involving an entire tendon with minimal retraction of the torn edge; usually 3 to 4 cm

CIV A massive rotator cuff tear involving two or more rotator cuff tendons, frequently with associated retraction and scarring of the remaining tendon ends and often L-shaped tear. The CIV classification can also be modified with the term irreparable, indicating that there is no possibility of direct repair

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