Background:
This study aimed to investigate the relationship between Hamada Grade and rotator cuff and long head of the biceps (LHB) pathologies in symptomatic patients with rotator cuff tears (RCTs).

Methods:
We retrospectively reviewed 376 patients (156 men and 220 women; mean age, 68.4 years) who had undergone surgery for complete RCTs. Preoperative plain radiography, magnetic resonance imaging, and intraoperative findings were assessed. All cases were allocated to the Hamada Grade 1, 2, 3, and 4-5 groups to investigate the correlation between Hamada Grade severity and underlying rotator cuff and LHB pathologies.

Results:
The rate of RCTs involving the infraspinatus was significantly higher in Grade 2 than in Grade 1 (P <  .0001). The tear size and fatty muscle degeneration of the subscapularis in Hamada Grade 3 were significantly more severe than those in Grade 2 (P = .01 and P <  .0001, respectively). The tear size and fatty muscle degeneration of the rotator cuff in Grade 4-5 were significantly more severe than those in Grade 3 (all P <  .05). The complete LHB rupture rate was significantly higher in Hamada Grade 4-5 than in Grades 1, 2, and 3 (all P <  .001).

Conclusion:
Rotator cuff tears involving the infraspinatus were associated with Hamada Grade 2. The rate of concomitant subscapularis tears with posterosuperior RCTs was significantly higher in Hamada Grade 3 than in Hamada Grade 2. RCT enlargement, progression of fatty muscle degeneration of the subscapularis and posterosuperior rotator cuff muscles, and the increase in complete LHB rupture were associated with Hamada Grade 4-5.





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