Abstract
Introduction and Aims: To determine differences in rotator cuff tissue with duration of symptoms and tear size
Method: Rotator cuff tissue was obtained at debridement from 44 patients undergoing surgical repair. Pathological assessment was performed on H& E sections. Features evaluated included inflammation, micro-calcification, tendolipomatosis and fibroblast hypocellularity. Matrix quality and endothelial cell proliferation were examined. Patient details – age, tear size and duration of symptoms were extracted from notes.
Results: Matrix quality was significantly worse in small tears (p=0.028), particularly the extent of mucoid degeneration in the debrided tissue (p=0.017). Presence of a healthy cut margin was more likely in a large tear (10/14). Poor matrix was significantly associated with symptom duration > 15months (p=0.006) especially microcalicification (p=0.019) and mucoid degeneration (p=0.047). Endothelial cell proliferation was significantly more apparent in patients with longer duration of symptoms: previous vascular tufting (p=0.001) and ongoing vascular proliferation (p=0.019). Of 27 patients > 15months symptoms, vascular proliferation was strongly correlated with split collagen fibres (p< 0.018) and mucoid degeneration (p< 0.018) but not microcalcification. Tendolipomatosis was strongly correlated with ongoing vascular proliferation (p< 0.0006).
Conclusion: Successful surgical repair is only achieved in 30% patients with rotator cuff tears. Improvements in this success rate will be essential in order to maintain the independent lifestyle of an elderly population. Although the tissue examined here is debrided, and hence worst case tissue, several time-dependent processes are ongoing, degeneration, repair and remodelling. Matrix quality is deteriorating, however, this maybe supportive of the angiogenic component of repair. Remodelling may be seen in the increased probability of a healthy cut margin from patients with longer symptom duration.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
