Journal List > Korean J Sports Med > v.37(4) > 1139114

Ku, Cho, and Kim: Traumatic Posterior Rotator Cuff Tear in the Pre-existing Chronic Supraspinatus Tendon Tear



This study aimed to evaluate the diagnostic characteristics and clinical results after surgical repair of traumatic superimposed posterior rotator cuff tear in the setting of preexisting retracted supraspinatus tendon tear.


A total of 20 patients (mean age, 62.1 years) were included and all patients had significant traumatic events mean 3.7 weeks prior to the surgery. Preoperative acromiohumeral distance (AHD, mean 3.2 mm) and arthritis change were analyzed on plain radiograph and magnetic resonance imaging was evaluated for the nature and extent of torn tendon, and fatty degeneration (FD) of all cuff muscles to validate if the tears were traumatic or chronic.


Complete repairs were achieved in 15 patients and partial repair including posterior cuff in five. Functional and radiographic results were statistically evaluated and repair integrities were assessed with ultrasound at average 17.3 months. Overall functional outcome scores were significantly improved and 17 patients (85%) were satisfied with their symptoms. AHD was significantly recovered (mean, 6.7 mm), but two patients showed progression of arthritic change. Retears after the complete repair were three patients (20%), who showed poor outcome, with advanced preoperative FD of posterior cuff muscles. Five patients with partial repair of posterior cuff revealed improved functional score with no sign of retear of posterior cuff on ultrasound.


Early recognition of traumatic superimposed posterior cuff tears and surgical repair can reliably restore shoulder function, and partial repair of posterior cuff also can be expected favorable outcomes in supraspinatus tear with advanced FD.

Figures and Tables

Fig. 1

Preoperative magnetic resonance images of right shoulder in 64-year-old male after trauma. (A) T2-weighted coronal image shows retracted supraspinatus tendon and no muscle edema. T2-weighted axial (B) and coronal image (C) show intramuscular high signal intensity corresponding acute muscle edema and wavy contoured torn tendon edges (white arrows). (D) T1 weighted oblique sagittal image shows fatty degeneration of cuff muscles; supraspinatus grade II, Infraspinatus and teres minor; grade I.

Fig. 2

Intraoperative arthroscopic images of right shoulder in 59-year-old male show (A) smooth torn edge and relatively poor mobility of preexisting supraspinatus tear and (B) bursal hematoma on infraspinatus and (C) final construct is shown with direct repair of infraspinatus and partial repair of supraspinatus using biceps tendon.

Fig. 3

Anteroposterior radiographs of right shoulder to measure the acromiohumeral interval in 57-year-old male with superimposed infraspinatus tear show (A) marked narrowing of acromiohumeral interval to 2.4 mm and upper migration of humeral head after trauma. (B) After arthroscopic repair, increased the interval to 6.2 mm in 15 months postoperative follow-up. Preop: preoperation, PO: postoperation.

Fig. 4

Three cases of postoperative retear after complete repair of superimposed acute posterior cuff tear in pre-existing supraspinatus tear and preoperative and follow-up X-ray, magnetic resonance and ultrasonographic images. (A) Fifty-nine-year-old male with grade III fatty degeneration of teres minor (white arrow) had upper migration of humeral head and retear of infraspinatus. (B) Sixty-seven-year-old male also had grade II teres minor fatty degeneration (white arrow). Hamada III rotator cuff tear arthropathy and infraspinatus retear were revealed in final follow-up. (C) Sixty-two-year-old male with grade II infraspinatus fatty degeneration (white arrow) showed marked upper migration of humeral head and complete retear of infraspinatus on ultrasonography in final follow-up.

Fig. 5

A case of partial repair of posterior cuff in 58-year-old male. (A) Preoperative radiograph shows marked narrowing of acromiohumeral interval. (B) T2 weighted coronal and (C) axial image show retracted supraspinatus tear and acute superimposed infraspinatus tear (white arrow). (D) Seventeen months after partial repair with margin convergence, acromiohumeral interval is recovered and no sign of retear of (E) supraspinatus and (F) infraspinatus on ultrasonography (white arrows). Preop: preoperative, PO: postoperative.

Table 1

Demographic characteristics of the 20 patients


Values are presented as mean±standard deviation or number (%).

Table 2

Fatty degeneration of each rotator cuff muscle


SD: standard deviation.

*Goutallier grade7.

Table 3

Summary of operative procedures in 20 cases


Values are presented as number (%).

*Partial repair including three margin convergence repairs and two biceps incorporations after complete repair of posterior rotator cuff.

Table 4

Summary of functional outcome at postoperative final follow-up*


Values are presented as mean±standard deviation.

VAS: visual analog scale, ROM: range of motion, STT: Simple Shoulder Test, KSS: Korean Shoulder Society. *Mean, 17.3±10.1 months; Indicates statistical significance.

Table 5

Structural characteristics of three cases of postoperative retear after complete repair


SSP: supraspinatus, ISP: infraspinatus, TM: teres minor, AHD: acromiohumeral distance, Preop: preoperative.

*Goutallier grade, numerical; Hamada classification.

Table 6

Structural characteristics of five cases with healed infraspinatus after partial repair at final follow-up


SSP: supraspinatus, ISP: infraspinatus, TM: teres minor, AHD: acromiohumeral distance, Preop: preoperative.

*Goutallier grade, numerical; Hamada classification.


Conflict of Interest No potential conflict of interest relevant to this article was reported.


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Jung Hoei Ku

Hyung Lae Cho

Jong Min Kim

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