An erratum to this article can be found at http://dx.doi.org/10.1186/s12891-015-0833-6.
An erratum to this article is available at http://dx.doi.org/10.1186/s12891-015-0833-6.
The authors declare that they have no competing interests.
CHJ: conception and design, collection and/or assembly of data, data analysis, manuscript preparation; SJS: collection and/or assembly of data, data analysis; JEK: collection and/or assembly of data, data analysis; SO: Statistical data analysis. All authors read and approved.
Whereas synovitis is one of most common findings during arthroscopic surgery in patients with rotator cuff diseases, no study has investigated its characteristics. We propose a macroscopic assessment system for investigating the characteristics of synovitis.
Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included. For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space. For the microscopic assessments, 4 commonly used microscopic assessment systems were used. The reliability and association between the macroscopic and microscopic assessments were investigated.
The inter- and intra-observer reliability of all of the macroscopic and microscopic assessments were excellent. The severity of synovitis was significantly greater in the glenohumeral joint than that in the subacromial space, 1.54 ± 0.61 versus 0.94 ± 0.56 (p < 0.001). Synovitis varied with respect to location, and was generally more severe near the tear with the macroscopic assessment system. Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space.
The macroscopic assessment system for synovitis in rotator cuff disease in this study showed excellent reliability. It critically described characteristics of synovitis that microscopic assessment systems could not. Therefore, this system could be a useful tool for investigating synovitis in rotator cuff disease.
Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998;57:649–55. CrossRefPubMedPubMedCentral
Meislin RJ, Sperling JW, Stitik TP. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop (Belle Mead NJ). 2005;34:5–9.
Fukuda H. Shoulder impingement and rotator cuff disease. Curr Orthop. 1990;4:225–32. CrossRef
NEER CS. Impingement lesions. Clin Orthop Relat Res. 1983;173:70–7. PubMed
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83. PubMed
Feeney MS, O’Dowd J, Kay EW, Colville J. Glenohumeral articular cartilage changes in rotator cuff disease. J Shoulder Elb Surg. 2003;12:20–3. CrossRef
Gotoh M, Hamada K, Yamakawa H, Nakamura M, Yamazaki H, Ueyama Y, et al. Perforation of rotator cuff increases interleukin 1beta production in the synovium of glenohumeral joint in rotator cuff diseases. J Rheumatol. 2000;27:2886–92. PubMed
Ostergaard M, Stoltenberg M, Lovgreen-Nielsen P, Volck B, Jensen CH, Lorenzen I. Magnetic resonance imaging-determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis: comparison with the macroscopic and microscopic appearance of the synovium. Arthritis Rheum. 1997;40:1856–67. CrossRefPubMed
Gotoh M, Hamada K, Yamakawa H, Yanagisawa K, Nakamura M, Yamazaki H, et al. Interleukin-1-induced subacromial synovitis and shoulder pain in rotator cuff diseases. Rheumatology (Oxford). 2001;40:995–1001. CrossRef
Voloshin I, Gelinas J, Maloney MD, O’Keefe RJ, Bigliani LU, Blaine TA. Proinflammatory cytokines and metalloproteases are expressed in the subacromial bursa in patients with rotator cuff disease. Arthroscopy. 2005;21:1076 e1071–9. CrossRef
Ishii H, Brunet JA, Welsh RP, Uhthoff HK. “Bursal reactions” in rotator cuff tearing, the impingement syndrome, and calcifying tendinitis. J Shoulder Elb Surg. 1997;6:131–6. CrossRef
Loeuille D, Chary-Valckenaere I, Champigneulle J, Rat AC, Toussaint F, Pinzano-Watrin A, et al. Macroscopic and microscopic features of synovial membrane inflammation in the osteoarthritic knee: correlating magnetic resonance imaging findings with disease severity. Arthritis Rheum. 2005;52:3492–501. CrossRefPubMed
Fleiss J. The design and analysis of clinical experiments. New York: Taylor & Francis; 1986.
de Lange-Brokaar BJ, Ioan-Facsinay A, Yusuf E, Visser AW, Kroon HM, Andersen SN, et al. Degree of synovitis on MRI by comprehensive whole knee semi-quantitative scoring method correlates with histologic and macroscopic features of synovial tissue inflammation in knee osteoarthritis. Osteoarthritis Cartilage. 2013;22(10):1606–13. CrossRefPubMed
- Macroscopic and microscopic assessments of the glenohumeral and subacromial synovitis in rotator cuff disease
Chris H. Jo
Ji Sun Shin
Ji Eun Kim
- BioMed Central
Neu im Fachgebiet Orthopädie und Unfallchirurgie
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