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Rotator Cuff Classifications

  1. Matsen’s clinical entities associated with rotator cuff pathology
  2. Cofield Classification of Rotator Cuff Tears (Cofield 1982)
  3. Complete cuff tears: Bateman Classification
  4. Full thickness rotator cuff tear :Ellman and Gartsman Classification
  5. Partial Thickness rotator cuff tears : Arthroscopic classification by Ellman
  6. Cuff tear retraction in the frontal plane : Patte Classification
  7. Southern California Orthopaedic Institute rotator cuff classification system.(Snyder)
  8. Topographic classification of rotator cuff tears in the sagittal plane : Patte
  9. Topographic classification of rotator cuff tears in the sagittal plane : Habermeyer
  10. Supraspinatus muscle atrophy on MRI: Thomazeau classification
  11. Fatty degeneration of cuff muscles: Goutallier’s classification using CT scan
  12. Subscapularis Tear Classification - LaFosse
  13. Subscapularis tendon tear: Fox and Romeo classification


Matsen’s clinical entities associated with rotator cuff pathology (Matsen 1998)

1. Asymptomatic cuff failure
2. Posterior capsular tightness
3. Subacromial abrasion without significant defect in the rotator cuff
4. Partial thickness cuff lesion
5. Full thickness cuff tear
6. Cuff tear arthropathy
7. Failed acromioplasty
8. Failed cuff surgery

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Cofield Classification of Rotator Cuff Tears (Cofield 1982)
Cofield, Surg Gynec Obstet, 154(5): 667-672, 1982

Small < 1cm
Medium 1-3 cm
Large 3-5 cm
Massive >5cm

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Complete cuff tears: Bateman Classification
Bayne O, Bateman J E. Surgery of the Shoulder, Edited by Bateman, Mosby 1984

Grade 1- Tear < 1cm after debridement
Grade 2 – tear 1-3 cm after debridement
Grade 3- < 5 cms
Grade 4- Global tear, no cuff left

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Full thickness rotator cuff tear: Ellman and Gartsman Classification (Ellman 1993)
Ellman H, Gartsman G, Open repair of full thickness RCT. Pg 181-202, Philadelphia, 1993

1 - Crescent
2 - Reverse L
3 - L shaped
4 - Trapezoidal
5 - Massive tear Full thickness rotator cuff tears

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Partial Thickness rotator cuff tears : Arthroscopic classification by Ellman
Ellman H, CORR, (254) 64-74, 1990

Grade 1: Partial tear < 3mm deep

Grade 2: Partial tear 3-6 mm deep
               depth not exceeding one-half of the tendon thickness

Grade 3: Partial tear > 6mm deep.

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Cuff tear retraction in the frontal plane : Patte Classification
Patte D, CORR, (254) 81-86, 1990

Stage 1: Proximal stump close to bony insertion
Stage 2: Proximal stump at level of humeral head
Stage 3: Proximal stump at glenoid level

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Southern California Orthopaedic Institute rotator cuff classification system.(Snyder)
Snyder S J, Shoulder Arthroscopy, pg 210-207, Philadelphia , Lippincott Williams and Wilkins 2003

Comprehensive classification including the size position and quality of tendon.

Location
A - Articular surface
B - Bursal surface
C - Complete tear

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Southern California Orthopaedic Institute (SCOI) Rotator cuff tear classification system (Snyder)
Partial thickness tears

0     Normal
1     Minimal superficial bursal or synovial irritation or slight capsular fraying over a small area
2     Fraying and failure of some rotator cuff fibres in addition to synovial bursal or capsular injury. More severe rotator cuff injury fraying and fragmentation of tendon fibres often involving the whole of a cuff tendon, usually <3cm
4     Very severe partial rotator cuff tear that contains a sizeable flap tear and more than one tendon

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Southern California Orthopaedic Institute rotator cuff classification system.(Snyder)
Full thickness rotator cuff tears

C1 - Small complete tear, pinhole sized
C2 - Moderate tear <2cm of only one tendon without retraction
C3 - Large complete tear with an entire tendon with minimal retraction usually 3-4 cm
C4 - Massive rotator cuff tear involving 2 or more rotator cuff tendons with associated retraction and scarring of the remaining tendon.

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Topographic classification of rotator cuff tears in the sagittal plane : Patte
Patte D, CORR, (254) 81-86, 1990

Segment 1: Isolated Subscapularis tear
           Usually traumatic associated with LHB dislocation

Segment 2: Isolated Coracohumeral ligament tear

Segment 3: Isolated Supraspinatus tear
          Seg 3 + Seg 1 combination = anterosuperior defect

Segment 4: Complete supra and one-half infraspinatus tear

Segment 5: Complete supra and infraspinatus tear

Segment 6: Complete subscapularis, supra and infraspinatus tear



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Topographic classification of rotator cuff tears in the sagittal plane : Habermeyer
Habermeyer, JBJS (A) 2006

Sector A: Anterior lesions- Subscap tendon, rotator interval and LHB tendon
Sector B: Central superior lesions- Supraspinatus tendon
Sector C: Posterior lesions- Infraspinatus and teres minor lesions

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Supraspinatus muscle atrophy on MRI: Thomazeau classification
Thomazeau et al, Acta Orthop Scand, 67(3): 264-68, 1996

Stage 1: Normal/ slight atrophy   Occupation ratio(1.00-0.60)
Stage 2: Moderate atrophy       Occupation ratio(0.60-0.40)
Stage 3: Severe atrophy       Occupation ratio(<0.40)

Occupation ratio R = S1 / S2

S1= surface of supraspinatus muscle
S2= surface of entire supraspinatus fossa

Measurement on the scapular cut at level of medial border of spine of scapula

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Fatty degeneration of cuff muscles: Goutallier’s classification using CT scan
Goutallier et al, CORR, 304:78-83, 1994

Prognostic importance. Stages 3 and 4 have less chance of return to function
Stage 0 - Normal muscle
Stage 1 - Some fatty streaks
Stage 2 - Less than 50% fatty muscle atrophy
Stage 3 - 50% fatty muscle atrophy
Stage 4 - Greater than 50% fatty muscle atrophy

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Subscapularis Tear Classification - LaFosse
Laurent Lafosse, Bernhard Jost, Youri Reiland, Stéphane Audebert, Bruno Toussaint and Reuben Gobezie. J Bone Joint Surg Am. 2007;89:1184-1193.

Based on Intraoperative Evaluation and Preoperative CT / MR
Type     Lesion
I         Partial lesion of superior one-third

II        Complete lesion of superior one-third

III       Complete lesion of superior two-thirds

IV       Complete lesion of tendon but head centred and fatty degeneration classified as less than or equal to Goutalier stage III

V        Complete lesion of tendon but eccentric head with coracoid impingement and fatty degeneration classified as more than or equal to Goutalier stage III

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Subscapularis tendon tear: Fox and Romeo classification
Fox J, Romeo A A, in the annual meeting of AAOS, New Orleans, 2003

Type 1: Partial thickness tear
Type 2: complete tear of upper 25 % of subscap tendon
Type 3: complete tear of upper 50 % of subscap tendon
Type 4: complete rupture of subscap tendon

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