From the Guidelines
Delamination of the rotator cuff should be addressed during surgical repair by converting the delaminated tear into a single layer before repair, as this technique has been shown to improve outcomes and reduce the risk of re-tear 1. This approach involves identifying the delamination, which appears as a horizontal split between the articular and bursal layers of the rotator cuff tendon, and then suturing these separated layers together before anchoring them to the bone. Some key points to consider in the treatment of delamination of fibers in rotator cuff repair include:
- Identifying the delamination and suturing the separated layers together before anchoring them to the bone
- Using high-strength sutures in a side-to-side fashion to unify the layers, followed by standard suture anchors to secure the repaired tendon to the humeral footprint
- Complete debridement of any degenerative tissue within the delamination is essential before repair
- Post-operatively, patients should follow a standard rotator cuff rehabilitation protocol with 4-6 weeks of immobilization, followed by progressive range of motion exercises and strengthening at 8-12 weeks
- Delaminated tears require special attention because they represent more complex injuries with poorer tissue quality and higher re-tear rates if not properly addressed
- The horizontal split weakens the overall tendon structure, and failure to recognize and treat delamination can lead to persistent pain and functional limitations even after repair
- Anatomically, delamination occurs due to differential strain patterns between the deeper and superficial fibers during injury, creating shear forces that separate these layers, as noted in studies such as 1 and 1. It is also important to consider the use of pain management strategies, such as those outlined in 1 and 1, to optimize patient outcomes and minimize the risk of complications. Overall, the treatment of delamination of fibers in rotator cuff repair requires a comprehensive approach that takes into account the complex anatomy and biomechanics of the rotator cuff, as well as the need for careful surgical technique and post-operative rehabilitation.
From the Research
Treatment for Delamination of Fibers in Rotator Cuff Repair
The treatment for delamination of fibers in rotator cuff repair involves various surgical techniques. Some of the key points to consider are:
- Independent repair of the superficial layer (infraspinatus) and the deep layer (articular capsule) has been proposed as a technique to repair delamination 2
- Double-layer rotator cuff repair, which involves anatomic reconstruction of the superior capsule and rotator cuff, has been shown to improve biomechanical properties in repairs of delaminated rotator cuff tears 3
- Arthroscopically assisted mini-open rotator cuff repair has been found to produce reliable outcomes in the presence of delamination tearing 4
- The extension of delamination and cuff integrity after arthroscopic rotator cuff repair can be evaluated using computed tomography arthrography 5
Surgical Techniques
Some of the surgical techniques used to treat delamination of fibers in rotator cuff repair include:
- Double-row suture repair with medial row knots
- Knotless double-row repair using suture tapes
- Knotless double-row, double-layer-specific repair
- Independent repair of the superficial layer (infraspinatus) and the deep layer (articular capsule)
Key Considerations
Some key considerations when treating delamination of fibers in rotator cuff repair include:
- The incidence of delamination, which has been reported to be as high as 71% of rotator cuff tears 4
- The effect of delamination on the outcome of rotator cuff repair, which has been found to be negative in some studies 3
- The importance of anatomical reconstruction of the superior capsule and rotator cuff in improving biomechanical properties 3
- The use of computed tomography arthrography to evaluate cuff integrity after arthroscopic rotator cuff repair 5