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Histopathology of the Supraspinatus Tendon in Rotator Cuff Tears

Umile Giuseppe Longo, MD^*, Francesco Franceschi, MD^*, Laura Ruzzini, MD^*, Carla Rabitti, MD, Sergio Morini, MD, Nicola Maffulli, MD, PhD, FRCS (Orth)^, and Vincenzo Denaro, MD^*

From the ^* Department of Orthopaedic and Trauma Surgery and the Department of Surgical Pathology, Campus Biomedico University, Rome, Italy, and Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, University Hospital of North, Staffordshire, Stoke on Trent, United Kingdom

Address correspondence to Nicola Maffulli, MD, Thornburrow Drive, Hartshill, Stoke on Trent, ST4 7QB Staffordshire, United Kingdom (e-mail: osa14{at}keele.ac.uk)

Background: Causes of rotator cuff pathology are poorly understood.

Hypothesis: Macroscopically intact supraspinatus tendon may show profound light microscopy changes. These changes may be the pathogenic precursor to a subsequent rotator cuff tear.

Study Design: Comparative laboratory study.

Methods: Tendon samples were harvested from 88 individuals (49 men, 39 women; mean age, 58.2 years) who had sustained a rotator cuff tear and underwent arthroscopic repair of the lesion, and from 5 male patients who died of cardiovascular events (mean age, 69.6 years). A full-thickness supraspinatus tendon biopsy specimen was harvested en bloc within the arthroscopically intact middle portion of the tendon between the lateral edge of the tendon tear and the muscle-tendon junction. Slides stained with hematoxylin and eosin were interpreted twice by the same observer using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. Intraobserver reliability of the subscore readings was calculated.

Results: The mean pathologic sum-score of ruptured tendons was significantly greater than the mean pathologic score of control tendons (15.66 ± 1.82 vs 3.7 ± 2.31, P = .001). Within each specific category of tendon abnormalities, the control and ruptured tendons were significantly different (² test); all variables were significantly different (Mann-Whitney U test <0.05; P = .001). The agreement between the 2 readings ranged from 0.56 to 0.86 (kappa statistics).

Conclusion: Nonruptured supraspinatus tendons, even at an advanced age, and ruptured supraspinatus tendons are clearly part of 2 distinct populations.

Clinical Relevance: During cuff repair, it is not necessary to excessively freshen the torn tendon to bleeding tissue: the macroscopically intact supraspinatus tendon is degenerated as well, and the failed healing response is not limited to the ends of the torn tendon.

Key Words: rotator cuff • histology • shoulder • arthroscopy • supraspinatus tendon

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