title: A radiographic classification of massive rotator cuff tear arthritis.
abstract: BACKGROUND
  In 1990, Hamada et al. radiographically classified massive rotator cuff tears into five grades. Walch et al. subsequently subdivided Grade 4 to reflect the presence/absence of subacromial arthritis and emphasize glenohumeral arthritis as a characteristic of Grade 4.
  
  
  OBJECTIVE
  We therefore determined (1) whether patient characteristics and MRI findings differed between the grades at initial examination and final followup; (2) which factors affected progression to a higher grade; (3) whether the retear rate of repaired tendons differed among the grades; and (4) whether the radiographic grades at final followup differed from those at initial examination among patients treated operatively.
  
  
  METHODS
  We retrospectively reviewed 75 patients with massive rotator cuff tears. Thirty-four patients were treated nonoperatively and 41 operatively.
  
  
  RESULTS
  Patients with Grade 3, 4, or 5 tears had a higher incidence of fatty muscle degeneration of the subscapularis muscle than patients with Grade 1 or 2 tears. In 26 patients with Grade 1 or 2 tears at initial examination, duration of followup was longer in patients who remained at Grade 1 or 2 than in those who progressed to Grade 3, 4, or 5 at final followup. The retear rate of repaired supraspinatus tendon was more frequent in Grade 2 than Grade 1 tears. In operated cases, radiographic grades at final followup did not develop to Grades 3 to 5.
  
  
  CONCLUSIONS
  We believe cuff repair should be performed before acromiohumeral interval narrowing. Our observations are consistent with the temporal concepts of massive cuff tear pathomechanics proposed by Burkhart and Hansen et al.
  
  
  METHODS
  Level III, Therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Hakone National Hospital, 412 Kazamatsuri, Odawara, Kanagawa 250-0032, Japan. kazuhama@muj.biglobe.ne.jp
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hamada
authors.forename: Kaoru
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: Takahiko
authors.initials: T
authors.lastname: Mikasa
authors.forename: Motohiko
authors.initials: M
authors.lastname: Mikasa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D001696:Biomechanical Phenomena; D018450:Disease Progression; D005260:Female; D006801:Humans; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D011859:Radiography; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012720:Severity of Illness Index; D013708:Tendon Injuries / Q000145:classification / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome