Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon

doi:10.1016/j.jse.2016.02.038

Journal of Shoulder and Elbow Surgery

Volume 25, Issue 12, December 2016, Pages 1944-1953

https://doi.org/10.1016/j.jse.2016.02.038 Get rights and content

Background

The purpose of this study was to investigate the accuracy of sagittal oblique view (SOV) magnetic resonance imaging grading for tears involving the upper third of the subscapularis tendons in correlation with arthroscopic findings. We also propose a schematic classification in the SOV for upper-third subscapularis tears.

Methods

The study analyzed 364 patients with an average age of 56.0 years. All patients underwent indirect magnetic resonance arthrography (MRA) before surgery. A slightly different magnetic resonance grading was introduced with SOV by musculoskeletal radiologists (Y.C.Y. and J.Y.Y.) and an orthopedic shoulder surgeon (H.Y.R.) who had no information about the clinical data. Subscapularis tendon tear classifications were all prospectively analyzed. Magnetic resonance grading was compared with the arthroscopic findings.

Results

The sensitivity, specificity, and accuracy of subscapularis tendon tear detection were 0.72, 0.77, and 0.75, respectively, for the radiologists. For the orthopedic surgeon, the corresponding values were 0.73, 0.83, and 0.79, respectively. The κ coefficients for interobserver agreement comparing magnetic resonance grade of the musculoskeletal radiologists with the arthroscopic grading showed fair values (κ value, 0.301). Interobserver agreement between the magnetic resonance grade of the orthopedic surgeon and arthroscopic grades was fair (κ value, 0.377). Interobserver agreement between the musculoskeletal radiologists and the orthopedic surgeon was moderate (κ value, 0.591).

Conclusions

The accuracy of SOV indirect MRA for detecting tears was 0.75 to 0.79. Although the correlation between magnetic resonance and arthroscopic grading was only fair, for most of the magnetic resonancegrading on SOV, the first facet view showed similar results compared with arthroscopy. The accuracy of determining whether subscapularis repair is indicated was 0.82 to 0.83 with SOV indirect MRA.

Section snippets

Selection of patients

From May 2011 to April 2013, there were 692 patients who underwent arthroscopic shoulder surgery in our institution. Among them, 364 patients (mean age, 56.0 years) had rotator cuff tendon tears (52.6%). An upper-third subscapularis tendon tear was present in 189 patients (51.9%). All patients included had intraoperative arthroscopic findings of subscapularis tendon tear documented in the medical record. The arthroscopic tear classification was performed in a prospective manner using a 70°

Correlation between preoperative magnetic resonance grade and arthroscopic finding

Interobserver agreement between the magnetic resonance and arthroscopic grades was fair by both musculoskeletal radiologists (κ value, 0.301; Table I) and the orthopedic shoulder surgeon (κ value, 0.377; Table II). Interobserver agreement between the musculoskeletal radiologists (Y.C.Y. and J.Y.Y.) and the orthopedic shoulder surgeon (H.Y.R.) was moderate (κ value, 0.591; Table III).

Detection of subscapularis tendon tear (κ, sensitivity, specificity, positive predictive value, negative predictive value)

According to the magnetic resonance grade by musculoskeletal radiologists, the sensitivity, specificity, and

Discussion

Our study showed that the SOV on preoperative indirect MRA can predict upper-third subscapularis tendon tears with an accuracy of 0.75 to 0.79, sensitivity of 0.72 to 0.73, and specificity of 0.77 to 0.83. Although this is much lowerthan detection rates for supraspinatus tendon tears (accuracy of 90%), it is still higher than with any other modality or image cut that has been reported. We were also able to predict with accuracy of 0.82 to 0.83 those patients who required subscapularis tendon

Conclusion

The accuracy of detection of tears of the upper third of the subscapularis tendon using SOV indirect MRA was 0.75 to 0.79. Although the correlation between magnetic resonance and arthroscopic grades was only fair, most of the magnetic resonance grading on the first facet SOV showed results similar to arthroscopy. The accuracy of preoperative predictions regarding the need for subscapularis repair was 0.82 to 0.83 with SOV indirect MRA.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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To evaluate the clinical and structural outcomes of using injectable atelocollagen during arthroscopic rotator cuff repair (ARCR) for small- to medium-sized rotator cuff tears.
This retrospective study reviewed patients with small- to medium-sized full-thickness tears who underwent ARCR from 2016 to 2022 with a minimum 1-year follow-up. Propensity score (PS) matching was used to reduce bias. Tendon integrity was evaluated using magnetic resonance imaging (MRI) at postoperative 6 months. Clinical and structural outcomes were compared between the 2 groups.
After PS matching, this study included 181 pairs of patients comparing ARCR with atelocollagen injection and without atelocollagen injection. Range of motion, muscle strength, and functional outcomes were significantly improved in both the atelocollagen group and the control group. Forward elevation and external rotation were significantly worse in the atelocollagen group compared with the control group at 2, 6, and 12 months postoperatively and at the final follow-up. In total, 125 patients (69.1%) in the atelocollagen group and 130 patients (71.8%) in the control group exceeded the minimal clinically important difference in the American Shoulder and Elbow Surgeons score without a significant difference between the 2 groups (P = .509). The mean value of Sugaya grade on postoperative MRI evaluation was 2.03 ± 0.81 for the atelocollagen group and 2.24 ± 0.97 for the control group, with a significant difference between the 2 groups (P = .027). Tendon healing failure was observed in 12 patients (6.6%) in the atelocollagen group and 19 patients (10.5%) in the control group, with no statistical difference between the 2 groups (P = .189).
Atelocollagen injection during ARCR for small- to medium-sized subacute or chronic rotator cuff tears did not show a benefit in clinical outcomes. However, postoperative MRI showed significantly lower Sugaya grade compared with the control group, with no significant difference in retear rate.
Level III, retrospective case-control study.
The Digitation Sign Facilitates Diagnosis of Shoulder Subscapularis Lesions on Preoperative Magnetic Resonance Imaging
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Citation Excerpt :
This low sensitivity is consistent with the current literature.9,29 The importance of using multiple imaging planes underlines the necessity of systematics approaches to improve sensitivity.31,33 With a systematic approach to imaging and a combination of 7 criteria, Lin et al.34 observed an overall sensitivity of 82.2%; specificity of 92.1%; positive and negative predictive values of 87.1% and 88.9%, respectively; and accuracy of 88.2%.
The purposes of this study were to investigate a radiographic sign found on coronal magnetic resonance imaging (MRI) sequences in subscapularis (SSC) pathology, reporting interobserver reliability data and sensitivity and specificity; and to correlate the preoperative assessment of SSC pathology with intraoperative assessment of the SSc during shoulder arthroscopy.
A consecutive series of patients undergoing arthroscopic rotator cuff repair from January 2020 to December 2020 were examined. The positive diagnosis of a subscapularis tendon tear was prospectively determined and confirmed by arthroscopy. The “digitation sign” was assessed by 3 independent shoulder-trained fellows when evaluating the SSC in the coronal plane on T2-weighted images.
Of the 132 patients included, 74 (56%) had SSC tendon tears confirmed during arthroscopy. Interobserver agreement for digitation sign was substantial (k= 0.640). Sensitivity for digitation sign only was 74.3%; for criteria of Adams et al. (Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy; Arthroscopy 2010;26:1427-1433) only, 83.8%; and for the combination of the 2 methods, 89.2%. Specificity was 84.5% for digitation sign only, 77.6% for Adams et al. criteria only, and 67.2% for the combination of the 2 methods. Sensitivity is statistically better when the digitation sign is added to the Adams et al. criteria for detection of SSC lesions. As expected, specificity is statistically lower. SSC tears are significantly associated with biceps lesions.
Preoperative systematic MRI evaluation by shoulder surgeons can diagnose subscapularis lesions by using the digitation sign in the coronal plane along with Adams et al. criteria, leading to good sensitivity. This easy-to-apply sign can be helpful in the initial MRI evaluation in the coronal plane, with improved sensitivity when combined with a systematic approach.
II, study of diagnostic test.
The AAOS 2019 Clinical Practice Guidelines for the Management of Rotator Cuff Injuries Are Unbiased and Incorporate a Diverse Body of Literature
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Citation Excerpt :
R. Z. Tashjian,18–20 A. Green,21–23 and V. Denaro9–11 were each credited as a senior author in 3 articles each, published over a range of 12 years (2006-2018). Frequency analysis of repeating authors in any position of authorship showed J. H. Oh,24–31 to be a contributing author in 8 unique studies; R. Z. Tashjian, in 6 studies18–20,22,23,32; S. H. Kim, in 5 studies24,26,29,31,33; and N. Maffulli,9–11,34 and J. C. Yoo35–38 in 4 studies published over a range of 12 years (2006-2018). Sixty-three other authors were listed as contributing authors in either 2 or 3 studies each.
To analyze the scientific research that formed the basis of the 2019 American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines for the management of rotator cuff injuries.
All studies cited in the 2019 AAOS clinical practice guidelines for the management of rotator cuff injuries were extracted and categorized. Extracted data included type of study, number of patients, level of evidence, journal of publication, impact factor, year of publication, country of origin, contributing authors, affiliated institutions, and significant findings. Data were analyzed to determine time from publication to implementation, level of evidence, and frequency of cited journals and authors.
The studies cited in the guideline included 15,130 patients from 140 studies published between 1994 and 2018. The overall mean time from article publication to 2019 AAOS clinical practice guidelines was 4.76 ± 2.23 years. Of articles published in 2010 to 2019, 64 studies were cited in the strong recommendation strength subcategory, and 57 articles were cited in the moderate recommendation strength subcategory. Articles published in Journal of Shoulder & Elbow Surgery and Arthroscopy were cited most frequently. The most frequent authors were J. H. Oh, R. Z. Tashjian, S. H. Kim, N. Maffulli, and J. C. Yoo.
The 2019 AAOS CPG reference a diverse number of journals and authors, appearing to be impartial. Furthermore, prompt time from publication to implementation in the Guidelines indicates that it is possible to influence clinical guidelines with recent work.
An analysis of the scientific research that forms the basis of the AAOS Clinical Practice Guidelines for the Management of Rotator Cuff Injuries can provide valuable information about the quality of the Guidelines.
Evaluation of subscapularis tendon tears of the anterosuperior aspect using radial-sequence magnetic resonance imaging
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Citation Excerpt :
It is especially difficult to diagnose a superior one-third tear. In the sagittal oblique view of magnetic resonance arthrography, good results were reported in which the sensitivity was 73%, the specificity was 83%, and the accuracy was 79%.26 However, magnetic resonance arthrography is an invasive examination as it requires an injection into the shoulder joint.
Magnetic resonance imaging (MRI) is widely used to diagnose subscapularis tendon tears; however, it is difficult to assess the anterosuperior aspect of these tears. Radial-sequence MRI can reveal the fiber components of the anterosuperior aspect, from perpendicular, by overcoming the partial volume effect. We aimed to classify the insertion of subscapularis tendon tears on radial-sequence MRI and determine the effectiveness of radial-sequence MRI for subscapularis tendon tear assessments.
We retrospectively investigated 196 patients (mean age, 66.7 ± 9.0 years; 118 men, 78 women) who underwent 1.5 T MRI before arthroscopic rotator cuff repair. Radial-sequence MRI findings of the anterosuperior aspect insertion of the subscapularis tendon were classified into five grades, and intraoperative findings compared with preoperative conventional MRI and radial-sequence MRI. We calculated sensitivity, specificity, accuracy, and positive and negative predictive values. Interobserver and intraobserver reliability for radial-sequence MRI classification was calculated using kappa (κ).
Conventional MRI sensitivity of subscapularis tendon tears was 45.3%; specificity, 95.8%; accuracy, 82.1%; positive predictive value, 80.0%; and negative predictive value, 82.5%. Radial-sequence MRI sensitivity was 92.5%; specificity, 88.1%; accuracy, 89.3%; positive predictive value, 74.2%; and negative predictive value, 96.9%. Sensitivity (P < .001), accuracy (P = .04), specificity (P = .02), and negative predictive values (P < .001) in radial-sequence MRI were significantly higher than those in conventional MRI. Intraobserver and interobserver reliabilities for radial-sequence MRI classification were κ = 0.78 and 0.65, respectively, corresponding to high reproducibility, and defined as good.
We provide evidence that radial-sequence MRI is an effective tool to evaluate subscapularis tendon tears, especially before surgery.
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High diagnostic accuracy of magnetic resonance imaging in detecting subscapularis tendon tears by focusing on the most superior portion of the subscapularis tendon
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View all citing articles on Scopus

: The study was approved by the Institutional Review Board at the Sungkyunkwan University College of Medicine, Samsung Medical Center: No. SMC 2014-12-045-001.

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Accuracy of sagittal oblique view in preoperative indirect magnetic resonance arthrography for diagnosis of tears involving the upper third of the subscapularis tendon

Background

Methods

Results

Conclusions

Section snippets

Selection of patients

Correlation between preoperative magnetic resonance grade and arthroscopic finding

Detection of subscapularis tendon tear (κ, sensitivity, specificity, positive predictive value, negative predictive value)

Discussion

Conclusion

Disclaimer

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Magn Reson Imaging

J Shoulder Elbow Surg

Arthroscopy

J Shoulder Elbow Surg