Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair
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To evaluate the diagnostic accuracy between magnetic resonance arthrography (MRA) and arthroscopic examination for the assessment of pathologies of the long head of the biceps (LHB) prior to rotator cuff (RC) repair. The hypothesis was that MRA is suitable to identify biceps instabilities, due to improved visibility of the biceps pulley.
Sixty-six patients aged 58.5 ± 17.6 (range, 46–71) scheduled to have RC repair between 2016 and 2017 were prospectively enrolled. MRA images of the LHB were interpreted by one radiologist and two surgeons, then compared to arthroscopic findings. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated by comparing MRA axial readings to arthroscopic assessment in the neutral position (static instability), MRA sagittal readings to arthroscopic assessment in external rotation (dynamic s instability), MRA coronal and axial readings to arthroscopic assessment in the neutral position (tendinopathy).
Among the three observers, the radiologist obtained the highest sensitivity and specificity for MRA, which were respectively: (1) for static instability, 62% (C.I. 35–85) and 77% (C.I. 63–88); (2) for dynamic instability, 50% (C.I. 29–71) and 62% (C.I. 46–77), and (3) for tendinopathy, 49% (C.I. 36–62) and 100% (C.I. 3–100).
MRA is not suitable for the diagnosis of LHB lesions prior to arthroscopic rotator cuff repair.
Level of evidence
Diagnostic study, Level I.
KeywordsMagnetic resonance arthrography Arthroscopic rotator cuff repair Lesion of the long head of the biceps Diagnostic accuracy
The authors are grateful to Mr. Mo Saffarini for his valuable assistance with study design and manuscript preparation.
The work was supported by the Groupement de Coopération Sanitaire Ramsay Générale de Santé pour l’Enseignement et la Recherche.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All patients provided informed consent for their participation in this study, which was approved by the institutional review board of Ramsay Générale de Santé in advance (COS-RGDS-2017-12-001).
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