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Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of the study was to evaluate the histopathological changes that occur in the tendon and subacromial bursal tissue in patients with rotator cuff tear trying to correlate these changes to their healing capability.

Methods

Eighty-four patients were clinically evaluated with the Constant Scale. Radiographs and MRI were performed preoperatively and ultrasound were performed postoperatively. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed, and the specimens were histopathologically analyzed.

Results

Tendons histopathological features consisted of loss of structural organization, poor or absent neoangiogenesis, chondral metaplasia, and fibrosis. Bursal features consisted of neoangiogenesis, absence of chondral metaplasia, hyperplasia/hypertrophy, and absence of necrosis. Direct correlation was seen between tendon and bursal hyperplasia and time of the onset of symptoms; between tendon chondral metaplasia, fibrosis, bursal neoangiogenesis, inflammation, and patient age; between tendon neoangiogenesis, hyperplasia, necrosis, fibrosis, bursal necrosis, inflammation, and lesion size; on the contrary, tendon fibrosis, necrosis, and bursal tissue inflammation decrease as time passes from the onset of symptoms. Tendon fibers disarray, neoangiogenesis, and inflammation decreases as the patient’s age increases. Bursal tissue fibrosis decreases as lesion size increases.

Conclusions

Simple histopathological techniques should be employed routinely to assess the tissue quality, with the aim to predict future clinical evolution (repair or non-repair). Comparing the histopathological data with the demographical information and the descriptive statistics, it is possible to define the RCT repair at risk and identify which RCT will be able to heal.

Level of evidence

II.

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Acknowledgment

The authors wish to thank Dr. Francesco Salate Santone, Istituto Guglielmo Tagliacarne, Roma, Italy, for his support in the statistical analysis. Mrs Tolani Lawson–Francis for reviewing the English.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Via Faggiana, 04100, Latina, Italy

    C. Chillemi, L. Garro & R. Diotallevi

  2. Department of Experimental Medicine, Sapienza University of Rome, Polo Pontino ICOT, Latina, Italy

    V. Petrozza, B. Sardella, A. Ferrara, C. Di Cristofano & C. Della Rocca

  3. Istituto Clinico Humanitas ICRSS, Rozzano (MI), Italy

    A. Castagna

  4. Istituto Politecnico delle Marche, Ancona, Italy

    A. Gigante

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  1. C. Chillemi
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  2. V. Petrozza
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  3. L. Garro
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  4. B. Sardella
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  5. R. Diotallevi
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  6. A. Ferrara
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  7. A. Gigante
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  8. C. Di Cristofano
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  9. A. Castagna
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  10. C. Della Rocca
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Corresponding author

Correspondence to C. Chillemi.

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Chillemi, C., Petrozza, V., Garro, L. et al. Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc 19, 1588–1596 (2011). https://doi.org/10.1007/s00167-011-1521-1

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  • DOI: https://doi.org/10.1007/s00167-011-1521-1

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