Advertisement

International Orthopaedics

, Volume 43, Issue 5, pp 1171–1177 | Cite as

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

  • Ilker ErenEmail author
  • Hakan Ozben
  • Caner Gunerbuyuk
  • Özgür Koyuncu
  • Murat Serhat Aygün
  • Edip Hatipoglu
  • Üstün Aydingöz
  • Mehmet Demirhan
Original Paper
  • 93 Downloads

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.

Keywords

Rotator cuff Shoulder arthroscopy Rotator cuff tear Tendon debridement Magnetic resonance imaging Tear measurement 

Notes

Author contribution

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).

References

  1. 1.
    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 CrossRefGoogle Scholar
  2. 2.
    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 CrossRefGoogle Scholar
  3. 3.
    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 CrossRefGoogle Scholar
  4. 4.
    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 CrossRefGoogle Scholar
  5. 5.
    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 CrossRefGoogle Scholar
  6. 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
  7. 7.
    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 CrossRefGoogle Scholar
  8. 8.
    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 CrossRefGoogle Scholar
  9. 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. 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
  11. 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 Google Scholar
  12. 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. 13.
    Neer CS (1990) Shoulder reconstruction. WB Saunders CompanyGoogle Scholar
  14. 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 CrossRefGoogle Scholar
  15. 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. 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
  17. 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 CrossRefGoogle Scholar
  18. 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. 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
  20. 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 CrossRefGoogle Scholar
  21. 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. 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 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedics and Traumatology, School of MedicineKoc UniversityIstanbulTurkey
  2. 2.Koc Universitesi HastanesiIstanbulTurkey
  3. 3.Department of Orthopaedics and TraumatologyAmerican HospitalIstanbulTurkey
  4. 4.Department of Radiology, School of MedicineKoc UniversityIstanbulTurkey
  5. 5.Department of Radiology, School of MedicineHacettepe UniversityAnkaraTurkey

Personalised recommendations