Elsevier

Journal of Shoulder and Elbow Surgery

Volume 17, Issue 6, November–December 2008, Pages 909-913
Journal of Shoulder and Elbow Surgery

Original Article
A new arthroscopic classification of articular-sided supraspinatus footprint lesions: A prospective comparison with Snyder's and Ellman's classification

https://doi.org/10.1016/j.jse.2008.06.007Get rights and content

The aim of this study was to find a descriptive rationale to quantify articular-sided supraspinatus tendon tears in the transverse and coronal planes, leading to a 2-dimensional description of the tear pattern. Fifty-six consecutive patients with articular-sided, symptomatic supraspinatus tendon tears diagnosed clinically and by magnetic resonance imaging underwent standardized diagnostic arthroscopy. Intra-articular findings of the rotator cuff were classified according to Ellman and Snyder. In addition, the longitudinal tear was assessed according to the length of the peeled-off bony footprint in the coronal plane. The sagittal tear extension was defined as a tear of the lateral reflection pulley on the medial border of the supraspinatus tendon and/or a tear in the area of the crescent zone. Statistically, we found a high correlation (r = 0.920, P < .0001) between the classifications of Ellman and Snyder, and we found only a slight correlation between the classifications of Snyder and Ellman with this new classification. Neither the classification of Snyder nor that of Ellman reproduced the extension of the partial-thickness rotator cuff tear in the transverse and coronal planes related to its etiologic pathomorphology.

Section snippets

Material and methods

From October 2002 to May 2004, 56 consecutive patients (26 men and 30 women) with a mean age of 54 years (range, 27-71 years) who had an articular-sided anterosuperior rotator cuff tear, diagnosed clinically and by magnetic resonance imaging, underwent standardized diagnostic arthroscopy and were prospectively documented by use of an intraoperative documentation sheet.

Of the patients, 26 (46.4%) reported a traumatic history, and the mean duration of symptoms was 24.6 months (range, 1 week to 25

Results

In 56 patients, an articular-sided partial-thickness rotator cuff tear was confirmed arthroscopically. Of these 56, 16 (28.6%) had a combined articular-sided supraspinatus and subscapularis tendon tear.

A positive cable sign was found in 62.5% (35 patients).

When the partial-thickness supraspinatus tendon tears were classified according to Ellman,4 26 patients (46.4%) had an A 1 tear, 13 (23.2%) had an A 2 tear, and 17 (30.4%) had an A 3 tear.

When the articular-sided supraspinatus tendon tears

Discussion

We describe a 2-dimensional classification of articular-sided supraspinatus tendon tears in the coronal plane as well as the sagittal plane, with regard to the origin of articular-sided partial tears at the tendon insertion. Within the entire patient group, we did not observe any articular-sided partial tear starting in the middle of the tendon without regard to the tendon insertion. Nearly 60% of our patients had a nontraumatic history.

Degenerative rotator cuff tears develop predominantly at

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