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Macroscopic and microscopic assessments of the glenohumeral and subacromial synovitis in rotator cuff disease.

Jo CH, Shin JS, Kim JE, Oh S - BMC Musculoskelet Disord (2015)

Bottom Line: Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included.For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space.Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. chrisjo@snu.ac.kr.

ABSTRACT

Background: Whereas synovitis is one of most common findings during arthroscopic surgery in patients with rotator cuff diseases, no study has investigated its characteristics. We propose a macroscopic assessment system for investigating the characteristics of synovitis.

Methods: Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included. For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space. For the microscopic assessments, 4 commonly used microscopic assessment systems were used. The reliability and association between the macroscopic and microscopic assessments were investigated.

Results: The inter- and intra-observer reliability of all of the macroscopic and microscopic assessments were excellent. The severity of synovitis was significantly greater in the glenohumeral joint than that in the subacromial space, 1.54 ± 0.61 versus 0.94 ± 0.56 (p < 0.001). Synovitis varied with respect to location, and was generally more severe near the tear with the macroscopic assessment system. Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space.

Conclusions: The macroscopic assessment system for synovitis in rotator cuff disease in this study showed excellent reliability. It critically described characteristics of synovitis that microscopic assessment systems could not. Therefore, this system could be a useful tool for investigating synovitis in rotator cuff disease.

No MeSH data available.


Related in: MedlinePlus

Macroscopic and microscopic findings of synovitis in the glenohumeral joint (upper row) and subacromial space (lower row) with arthroscopy. a The anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade, 2. b The posterior synovium in the glenohumeral joint. Villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. c The inferior synovium in the glenohumeral joint. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade, 0. d The microscopic findings of the anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.7; the Loeuille grade, 1.7; the modified Krenn grade, 2.0; the Scanzello grade, 2.0. e The anterior synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade, 2. f The posterior synovium in the subacromial space. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade 0. g The lateral synovium in the subacromial space. Villous hypertrophy, 2; hyperemia, 0; density, 0; grade, 1. h The microscopic finding of the lateral synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.3; the Loeuille grade, 1.2; the modified Krenn grade, 2.0; the Scanzello grade, 2.0
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Fig2: Macroscopic and microscopic findings of synovitis in the glenohumeral joint (upper row) and subacromial space (lower row) with arthroscopy. a The anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade, 2. b The posterior synovium in the glenohumeral joint. Villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. c The inferior synovium in the glenohumeral joint. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade, 0. d The microscopic findings of the anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.7; the Loeuille grade, 1.7; the modified Krenn grade, 2.0; the Scanzello grade, 2.0. e The anterior synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade, 2. f The posterior synovium in the subacromial space. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade 0. g The lateral synovium in the subacromial space. Villous hypertrophy, 2; hyperemia, 0; density, 0; grade, 1. h The microscopic finding of the lateral synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.3; the Loeuille grade, 1.2; the modified Krenn grade, 2.0; the Scanzello grade, 2.0

Mentions: Biopsy specimens were immediately fixed in neutral buffered 10 % formalin. Subsequently, the specimens were embedded in paraffin, sectioned, and stained with hematoxylin and eosin (H&E). Microscopic assessment was performed according to 4 commonly used microscopic assessment systems for synovitis; the Østergaard, Loeuille, modified Krenn, and Scanzello systems (Fig. 2) [21, 35–37]. For the Østergaard grade [21], the following parameters were used: 1) subsynovial infiltration of polymorphonuclear leucocytes; 2) subsynovial infiltration of mononuclear leucocytes; 3) surface fibrin deposition; 4) multiplication of the synovial lining; 5) villous hypertrophy of the synovial surface; 6) proliferation of blood vessels; 7) perivascular edema; 8) formation of granulation tissue; 9) fibrosis. For the Loeuille grade [37], six parameters were examined: 1) number of synovial lining cells; 2) subsynovial infiltration by lymphocytes and plasma cells; 3) surface fibrin deposition; 4) congestion related to blood vessel vasodilatation and, to a minor degree, blood vessel proliferation; 5) fibrosis, and 6) perivascular edema. For the modified Krenn grade [36], three parameters were included: 1) synovial lining layer, 2) degree of inflammatory infiltration, and 3) activation of resident cells and synovial stroma including fibroblasts, endothelial cells, histiocytes, macrophages, and multinucleated giant cells. For the Scanzello grade [35], the synovial inflammation was graded based on perivascular mononuclear cell infiltration in synovium; 0 non, 1, 0–1 perivascular aggregates per low-power field, 2, > 1 perivascular aggregate per low-power field with or without focal interstitial infiltration, 3 marked aggregates both perivascular and interstitial.Fig. 2


Macroscopic and microscopic assessments of the glenohumeral and subacromial synovitis in rotator cuff disease.

Jo CH, Shin JS, Kim JE, Oh S - BMC Musculoskelet Disord (2015)

Macroscopic and microscopic findings of synovitis in the glenohumeral joint (upper row) and subacromial space (lower row) with arthroscopy. a The anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade, 2. b The posterior synovium in the glenohumeral joint. Villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. c The inferior synovium in the glenohumeral joint. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade, 0. d The microscopic findings of the anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.7; the Loeuille grade, 1.7; the modified Krenn grade, 2.0; the Scanzello grade, 2.0. e The anterior synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade, 2. f The posterior synovium in the subacromial space. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade 0. g The lateral synovium in the subacromial space. Villous hypertrophy, 2; hyperemia, 0; density, 0; grade, 1. h The microscopic finding of the lateral synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.3; the Loeuille grade, 1.2; the modified Krenn grade, 2.0; the Scanzello grade, 2.0
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Fig2: Macroscopic and microscopic findings of synovitis in the glenohumeral joint (upper row) and subacromial space (lower row) with arthroscopy. a The anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade, 2. b The posterior synovium in the glenohumeral joint. Villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. c The inferior synovium in the glenohumeral joint. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade, 0. d The microscopic findings of the anterior synovium in the glenohumeral joint. The macroscopic assessment was villous hypertrophy, 1; hyperemia, 1; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.7; the Loeuille grade, 1.7; the modified Krenn grade, 2.0; the Scanzello grade, 2.0. e The anterior synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade, 2. f The posterior synovium in the subacromial space. Villous hypertrophy, 0; hyperemia, 0; density, 0; grade 0. g The lateral synovium in the subacromial space. Villous hypertrophy, 2; hyperemia, 0; density, 0; grade, 1. h The microscopic finding of the lateral synovium in the subacromial space. The macroscopic assessment was villous hypertrophy, 2; hyperemia, 0; density, 1; grade 2. The microscopic assessments were the Østergaard grade, 1.3; the Loeuille grade, 1.2; the modified Krenn grade, 2.0; the Scanzello grade, 2.0
Mentions: Biopsy specimens were immediately fixed in neutral buffered 10 % formalin. Subsequently, the specimens were embedded in paraffin, sectioned, and stained with hematoxylin and eosin (H&E). Microscopic assessment was performed according to 4 commonly used microscopic assessment systems for synovitis; the Østergaard, Loeuille, modified Krenn, and Scanzello systems (Fig. 2) [21, 35–37]. For the Østergaard grade [21], the following parameters were used: 1) subsynovial infiltration of polymorphonuclear leucocytes; 2) subsynovial infiltration of mononuclear leucocytes; 3) surface fibrin deposition; 4) multiplication of the synovial lining; 5) villous hypertrophy of the synovial surface; 6) proliferation of blood vessels; 7) perivascular edema; 8) formation of granulation tissue; 9) fibrosis. For the Loeuille grade [37], six parameters were examined: 1) number of synovial lining cells; 2) subsynovial infiltration by lymphocytes and plasma cells; 3) surface fibrin deposition; 4) congestion related to blood vessel vasodilatation and, to a minor degree, blood vessel proliferation; 5) fibrosis, and 6) perivascular edema. For the modified Krenn grade [36], three parameters were included: 1) synovial lining layer, 2) degree of inflammatory infiltration, and 3) activation of resident cells and synovial stroma including fibroblasts, endothelial cells, histiocytes, macrophages, and multinucleated giant cells. For the Scanzello grade [35], the synovial inflammation was graded based on perivascular mononuclear cell infiltration in synovium; 0 non, 1, 0–1 perivascular aggregates per low-power field, 2, > 1 perivascular aggregate per low-power field with or without focal interstitial infiltration, 3 marked aggregates both perivascular and interstitial.Fig. 2

Bottom Line: Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included.For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space.Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea. chrisjo@snu.ac.kr.

ABSTRACT

Background: Whereas synovitis is one of most common findings during arthroscopic surgery in patients with rotator cuff diseases, no study has investigated its characteristics. We propose a macroscopic assessment system for investigating the characteristics of synovitis.

Methods: Fifty-four patients with a full-thickness rotator cuff tear undergoing arthroscopic rotator cuff repair with an average age of 62.5 ± 7.0 years were included. For the macroscopic assessment, 3 parameters, villous hypertrophy, hyperemia, and density, were measured and translated into grades in 3 regions-of-interest (ROI) in the glenohumeral joint and 4 ROIs in the subacromial space. For the microscopic assessments, 4 commonly used microscopic assessment systems were used. The reliability and association between the macroscopic and microscopic assessments were investigated.

Results: The inter- and intra-observer reliability of all of the macroscopic and microscopic assessments were excellent. The severity of synovitis was significantly greater in the glenohumeral joint than that in the subacromial space, 1.54 ± 0.61 versus 0.94 ± 0.56 (p < 0.001). Synovitis varied with respect to location, and was generally more severe near the tear with the macroscopic assessment system. Meanwhile, none of the microscopic assessment systems demonstrated differences between different ROIs in both the glenohumeral joint and the subacromial space.

Conclusions: The macroscopic assessment system for synovitis in rotator cuff disease in this study showed excellent reliability. It critically described characteristics of synovitis that microscopic assessment systems could not. Therefore, this system could be a useful tool for investigating synovitis in rotator cuff disease.

No MeSH data available.


Related in: MedlinePlus