Top

Published in:

01-05-2019 | Original Paper

Rotator cuff tear characteristics: how comparable are the pre-operative MRI findings with intra-operative measurements following debridement during arthroscopic repair?

Authors: Ilker Eren, Hakan Ozben, Caner Gunerbuyuk, Özgür Koyuncu, Murat Serhat Aygün, Edip Hatipoglu, Üstün Aydingöz, Mehmet Demirhan

Published in: International Orthopaedics | Issue 5/2019

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Cho NS, Rhee YG (2009) The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg 1(2):96–104. https://doi.org/10.4055/cios.2009.1.2.96 CrossRefPubMedPubMedCentral

Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD (2009) Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elb Surg 18(1):13–20. https://doi.org/10.1016/j.jse.2008.05.045 CrossRef

Tashjian RZ, Hollins AM, Kim H-M, Teefey SA, Middleton WD, Steger-May K, Galatz LM, Yamaguchi K (2010) Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 38(12):2435–2442. https://doi.org/10.1177/0363546510382835 CrossRefPubMed

Voigt C, Bosse C, Vosshenrich R, Schulz AP, Lill H (2010) Arthroscopic supraspinatus tendon repair with suture-bridging technique functional outcome and magnetic resonance imaging. Am J Sports Med 38(5):983–991. https://doi.org/10.1177/0363546509359063 CrossRefPubMed

Rol M, Favard L, Berhouet J (2018) Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data. Int Orthop 42(6):1347–1355. https://doi.org/10.1007/s00264-017-3616-x CrossRefPubMed

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 CrossRef

Nove-Josserand L, Saffarini M, Hannink G, Carrillon Y (2016) Influence of pre-operative tear size and tendon retraction on repair outcomes for isolated subscapularis tears. Int Orthop 40(12):2559–2566. https://doi.org/10.1007/s00264-016-3299-8 CrossRefPubMed

Hsu JE, Gorbaty J, Lucas R, Russ SM, Matsen FA 3rd (2017) Treatment of irreparable cuff tears with smoothing of the humeroscapular motion interface without acromioplasty. Int Orthop 41(7):1423–1430. https://doi.org/10.1007/s00264-017-3486-2 CrossRefPubMed

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 CrossRef

11.

Davidson JF, Burkhart SS, Richards DP, Campbell SE (2005) Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair. Arthroscopy 21(12):1428. https://doi.org/10.1016/j.arthro.2005.09.015 CrossRefPubMed

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):708–716CrossRef

13.

Neer CS (1990) Shoulder reconstruction. WB Saunders Company

14.

Davidson J, Burkhart SS (2010) The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy 26(3):417–424. https://doi.org/10.1016/j.arthro.2009.07.009 CrossRef

15.

Bigliani L, Morrison D, April E (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228

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 CrossRef

17.

Bryant L, Shnier R, Bryant C, Murrell GAC (2002) A comparison of clinical estimation, ultrasonography, magnetic resonance imaging, and arthroscopy in determining the size of rotator cuff tears. J Shoulder Elb Surg 11(3):219–224. https://doi.org/10.1067/mse.2002.121923 CrossRef

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 CrossRefPubMed

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 CrossRef

20.

Bonnevialle N, Bayle X, Faruch M, Wargny M, Gomez-Brouchet A, Mansat P (2015) Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder? J Shoulder Elb Surg 24(8):1257–1262. https://doi.org/10.1016/j.jse.2015.04.012 CrossRef

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

22.

Jain NB, Collins J, Newman JS, Katz JN, Losina E, Higgins LD (2015) Reliability of magnetic resonance imaging assessment of rotator cuff: the ROW study. PM R 7(3):245–254.e243; quiz 254. https://doi.org/10.1016/j.pmrj.2014.08.949 CrossRefPubMed

Title: Rotator cuff tear characteristics: how comparable are the pre-operative MRI findings with intra-operative measurements following debridement during arthroscopic repair?
Authors: Ilker Eren
Hakan Ozben
Caner Gunerbuyuk
Özgür Koyuncu
Murat Serhat Aygün
Edip Hatipoglu
Üstün Aydingöz
Mehmet Demirhan
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 5/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4130-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Rotator cuff tear characteristics: how comparable are the pre-operative MRI findings with intra-operative measurements following debridement during arthroscopic repair?

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2019

What parameters affect knee function in patients with untreated cartilage defects: baseline data from the German Cartilage Registry

Intraprosthetic dislocation of dual mobility total hip arthroplasty: still occurring?

Clinical study of anterior hip ultrasound (van Douveren’s method)-assisted Pavlik harness

Multicentre comparative study of Z-shape elevating–pulling reduction and skull traction reduction for treatment of lower cervical locked facets

Hemiarthroplasty for proximal humerus fractures with conservation of the whole humeral head as autograft: does it improve greater tuberosity healing?

Lateral column lengthening versus subtalar arthroereisis for paediatric flatfeet: a systematic review