MRI of symptomatic and asymptomatic full-thickness rotator cuff tears: A comparison of findings in 100 subjects (original) (raw)
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Acta Radiologica, 2014
Background: Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. Purpose: To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre-and postoperative clinical findings. Material and Methods: Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Results: Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P ¼ 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre-and postoperative physical examination or with postoperative clinical questionnaires scores. Conclusion: Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears.
Abstract Introduction: Rotator cuff tear (RCT) is one of the most common causes of shoulder pain and limitation of shoulder movements for which a patient presents to the clinic. MRI is the first choice of investigation for RCT but the accuracy of MRI in detection of Partial tendon tear(PTT) is still a topic of debate among researchers. Objective: The objective of this study is to re-evaluate the diagnostic efficacy of MRI for the detection of PTT and FTT using surgical finding as the ‘gold standard ‘ by improving the limitations of previous studies. Methods: All patients between January 2012 to January 2017 were preoperatively evaluated by means of complete orthopedic history, physical examination and MRI of the affected shoulder.The initial inspection of all the data only included 110 patients who had both MRI of the affected shoulder joints and subsequent surgery. Among them 13 patients were excluded as they did not undergo either arthroscopic or open surgery. In addition to that 4 more patients were excluded because of a time interval between MRI and surgery exceeded 2 months. The final study group consisted of 93 shoulders from 93 cases (63 female and 30 male) with the mean age of 56.85 years and range of 19 to 83 years. Kappa coefficient test was used to calculated the agreement between the MRI and surgical findings. A P-value less than 0.05 was considered statistically significant. Sensitivity, specificity, accuracy, the positive predictive value and the negative predictive value were calculated based on the cross tables. Results: MRI was able to correctly identify full thickness tear in 9 out of 10 patients with sensitivity, specificity, positive predictive value and negative predictive value of 90.0%, 100%, 100%, 98.9% and partial thickness tear in 70 out of 78 cases with sensitivity, specificity, positive predictive value and negative predictive value of 89.7%, 60%, 92.1%, 52.9% respectively. The accuracy for detection of FTT was 98.9% and PTT was 84.9% and the p value for both tears (FTT and PTT) was less than 0.05. There was a moderate agreement between MRI and surgery for PTT with k value of 0.472 and excellent agreement for FTT with k value of 0.94 . Conclusion: MRI has high accuracy, sensitivity and positive predictive value in diagnosis of both PTT and FTT and also provides an additional information about tendon, muscle and labrum, all of which are pivotal in better management of tear and improving the prognosis.
Interobserver Agreement in the Classification of Rotator Cuff Tears Using Magnetic Resonance Imaging
The American Journal of Sports Medicine, 2007
Background Although magnetic resonance imaging (MRI) is a standard method of assessing the extent and features of rotator cuff disease, the authors are not aware of any studies that have assessed the interobserver agreement among orthopaedic surgeons reviewing MRI scans for rotator cuff disease. Hypothesis Fellowship-trained orthopaedic shoulder surgeons will have good interobserver agreement in predicting the more salient features of rotator cuff disease such as tear type (full thickness versus partial thickness), tear size, and number of tendons involved but only fair agreement with more complex features such as muscle volume, fat content, and the grade of partial-thickness cuff tears. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Ten fellowship-trained orthopaedic surgery shoulder specialists reviewed 27 MRI scans of 27 shoulders from patients with surgically confirmed rotator cuff disease. The ability to interpret full-thickness versus partial-thickness te...
MR Evaluation of Factors Predicting the Development of Rotator Cuff Tears
Journal of Computer Assisted Tomography, 2001
The purpose of this work was to assess the incidence of various factors predicting impingement in the shoulder. Method: MR examination was used to assess various anatomic parameters in 46 patients with clinical abnormalities of the shoulder and 40 asymptomatic volunteers. All patients had undergone surgery, showing no rotator cuff tear. Results: A few of the parameters evaluated were significantly different in the two groups: The acromion was more frequently curved or hook-shaped in patients than in volunteers. The acromiohumeral distances differed (4.87 mm in patients and 6.05 mm in volunteers); so did the coracohumeral distances (7.9 mm in patients and 8.9 mm in volunteers). The shape of the acromioclavicular joint and the anterior covering of the humerus, defined on the coronal view, also differed (1.07 mm in patients and 1.49 mm in volunteers). Only the shapes of the acromioclavicular joint and of the acromion were linked with age. Conclusion: All these factors reflected a decrease in the acromiohumeral space, except for the anterior covering of the acromial arch, which could be due to anterior instability.
International Orthopaedics, 2018
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.
Detection of rotator cuff tears: the value of MRI following ultrasound
European Radiology, 2010
Objective To evaluate the need for additional magnetic resonance imaging (MRI) following ultrasound (US) in patients with shoulder pain and/or disability and to compare the accuracy of both techniques for the detection of partial-thickness and full-thickness rotator cuff tears (RCT). Methods In 4 years, 5,216 patients underwent US by experienced musculoskeletal radiologists. Retrospectively, patient records were evaluated if MRI and surgery were performed within 5 months of US. US and MRI findings were classified into intact cuff, partial-thickness and full-thickness RCT, and were correlated with surgical findings. Results Additional MR imaging was performed in 275 (5.2%) patients. Sixty-eight patients underwent surgery within 5 months. US and MRI correctly depicted 21 (95%) and 22 (100%) of the 22 full-thickness tears, and 8 (89%) and 6 (67%) of the 9 partial-thickness tears, respectively. The differences in performance of US and MRI were not statistically significant (p = 0.15). Conclusions MRI following routine shoulder US was requested in only 5.2% of the patients. The additional value of MRI was in detecting intra-articular lesions. In patients who underwent surgery, US and MRI yielded comparably high sensitivity for detecting full-thickness RCT. US performed better in detecting partial-thickness tears, although the difference was not significant.
Role of Magnetic Resonance Imaging in the Evaluation of Rotator Cuff Tears
Cureus, 2022
Background Magnetic resonance imaging (MRI), with the advent of surface coils, is becoming the modality of choice for imaging soft tissues around the shoulder joint. Good knowledge regarding the MR characteristics of rotator cuff tendons, acromion, and the abnormalities in these tendons is necessary for appropriate diagnosis. Methods This was a hospital-based descriptive, analytical and prospective study conducted at our tertiary care hospital. The study was performed on 50 patients with rotator cuff lesions detected on MRI of the shoulder joint. Results The age distribution found in the study is between 19 and 66 years with mean being 43 ± 14.8 years. The peak incidence was found in the fifth and sixth decades of life. Gender-wise distribution of rotator cuff pathologies has shown no significant gender variation. The pain was the most common presenting complaint. An abnormal supraspinatus tendon was seen in 82% of the 50 study patients, making it the most commonly affected tendons, followed by subscapularis and infraspinatus tendons. No apparent teres minor pathology was identified in the study patients. The most common pathology affecting the supraspinatus tendon was tendinosis (38%) closely followed by a partial tear (36%). Among the partial tears, the articular surface type of tear was the most common. About 52% patients had type II (curved) acromion; making it the most common type of acromion followed by type III (hook), supraspinatus tendinopathy was more common in type II acromion. A reduction in the acromiohumeral distance can cause supraspinatus tendinosis and also makes it more susceptible to tear. About 45.5% showed supraspinatus tendon tears when the acromiohumeral distance was less than 8mm as compared to 13.6% when more than 10mm. Only 4.2% had normal supraspinatus tendon in patients with this distance less than 7mm. Conclusion MRI provides valuable information to the orthopaedic surgeon regarding the status of tendons, bones, and joints. In order to choose the appropriate course of action, it is crucial first to identify the issue and report relevant data from rotator cuff imaging. A full grasp of the rotator cuff's architecture and function, as well as the repercussions of rotator cuff diseases, is required.