Rotator cuff tear characteristics: how comparable are the pre-operative MRI findings with intra-operative measurements following debridement during arthroscopic repair?
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Magnetic resonance (MRI) is a valuable imaging method which can detect pre-operative rotator cuff tear characteristics accurately. However, tendon degeneration almost always necessitates a certain amount of debridement during arthroscopic repair, which alters tear size and shape. The aim of this study is to question the accuracy of the pre-operative tear size and classification in MRI and its relation to the tear size and type of the debrided tendon during arthroscopic repair.
A retrospective survey was performed to identify shoulders that underwent arthroscopic rotator cuff repair. Rotator cuff tears with an adequate history, a standard pre-operative MRI, and available surgical video records with appropriate measurements were included. Traumatic tears, calcifying tendonitis, isolated subscapularis tears, and revisions were excluded. In total, 60 shoulders’ (30 males, 27 females; age 55.2 [35–73]) preoperative MRIs and intra-operative measurements were analyzed by orthopaedic surgeons and radiologists. Tear width and type were recorded. Interdisciplinary and intradisciplinary consistency of measurements and classifications were analyzed. Tear width measured on pre-operative MRI and after debridement were compared.
Average measured tear width was 9 ± 5.3 mm on MRI. Surgeons (9.98 ± 4.6 mm) measured tears significantly wider than radiologists (7.71 ± 6.6 mm). Radiologists (ICC, 0.930; CI, 0.883–0.959) showed superior consistency on MRI than surgeons (CI, 0.502; CI, 0.105–0.726). Average tear width measured after debridement (29.3 ± 9.6 mm) was significantly higher than tear width measured on pre-operative MRI (p < 0.0001). None of the researchers assessing tear type on pre-operative MRI showed agreement with surgeons assessing intra-operative data.
There were significant differences between the pre-operative tear characteristics on MRI and the debrided tendon characteristics during surgery, which were extensive enough to classify the tear in a different category.
KeywordsRotator cuff Shoulder arthroscopy Rotator cuff tear Tendon debridement Magnetic resonance imaging Tear measurement
All authors declare that they were involved in designing the study, collecting the data, analyzing the data, writing the manuscript, and confirming the accuracy of the data and the analyses.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Institutional review board approval
The study protocol was approved by the Medical Ethics Committee of the Koç University, Istanbul, Turkey (2015.149.IRB2.054).
- 6.Mihata T, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Fujiwara K, Kinoshita M (2011) Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears. Am J Sports Med 39(10):2091–2098. https://doi.org/10.1177/0363546511415660 CrossRefGoogle Scholar
- 9.Pander P, Sierevelt IN, Pecasse G, van Noort A (2018) Irreparable rotator cuff tears: long-term follow-up, five to ten years, of arthroscopic debridement and tenotomy of the long head of the biceps. Int Orthop. https://doi.org/10.1007/s00264-018-3991-y
- 10.Belangero PS, Ejnisman B, Arce G (2013) A review of rotator cuff classifications in current use. In: Arce G, Bak K, Shea PK et al (eds) Shoulder concepts 2013: consensus and concerns: proceedings of the ISAKOS upper extremity committees 2009–2013. Springer Berlin Heidelberg, Berlin, Heidelberg, pp 5–13. https://doi.org/10.1007/978-3-642-38097-6_2 CrossRefGoogle Scholar
- 12.Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K (2004) Detection and quantification of rotator cuff tears - comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am 86A(4):708–716CrossRefGoogle Scholar
- 13.Neer CS (1990) Shoulder reconstruction. WB Saunders CompanyGoogle Scholar
- 15.Bigliani L, Morrison D, April E (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228Google Scholar
- 16.Spencer EE, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, Ma CB, Jones G, Safran M, Holloway B, Kuhn JE (2008) Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med 36(1):99–103. https://doi.org/10.1177/0363546507307504 CrossRefGoogle Scholar
- 18.Dwyer T, Razmjou H, Henry P, Gosselin-Fournier S, Holtby R (2015) Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 23(2):415–422. https://doi.org/10.1007/s00167-013-2745-z CrossRefGoogle Scholar
- 19.Kida Y, Morihara T, Matsuda K, Kajikawa Y, Tachiiri H, Iwata Y, Sawamura K, Yoshida A, Oshima Y, Ikeda T, Fujiwara H, Kawata M, Kubo T (2013) Bone marrow-derived cells from the footprint infiltrate into the repaired rotator cuff. J Shoulder Elb Surg 22(2):197–205. https://doi.org/10.1016/j.jse.2012.02.007 CrossRefGoogle Scholar
- 21.Parks AN, McFaline-Figueroa J, Coogan A, Poe-Yamagata E, Guldberg RE, Platt MO, Temenoff JS (2016) Supraspinatus tendon overuse results in degenerative changes to tendon insertion region and adjacent humeral cartilage in a rat model. J Orthop Res n/a-n/a. https://doi.org/10.1002/jor.23496