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Intra- and Inter-rater Agreement on Magnetic Resonance Imaging Evaluation of Rotator Cuff Integrity After Repair

      Purpose

      To investigate the intra- and inter-rater agreement of magnetic resonance imaging (MRI) evaluations of rotator cuff integrity at 6 and 24 months after arthroscopic rotator cuff repair (ARCR).

      Methods

      Three shoulder surgeons reviewed 68 MRI scans from 34 patients who had undergone ARCR and MRI examination at both 6 and 24 months after surgery. Postoperative rotator cuff integrity was investigated by using Owen, Sugaya, and Hayashida classifications to determine whether the rotator cuff was intact or whether there was a partial-thickness retear or full-thickness retear and Burks score to assess tendon appearance. Multirater kappa statistics were used to measure intra- and inter-rater agreement. Kappa values were interpreted according to guidelines adapted from the work of Landis and Koch.

      Results

      All classifications had similar intra- and inter-rater agreement (κ = 0.14 to 0.67, 0.23 to 0.60, respectively), but no intra- or inter-rater agreement scored “excellent.” Inter-rater agreement after ARCR was higher at 24 months (κ = 0.31 to 0.60) than at 6 months (κ = 0.23 to 0.44) in all evaluations. Reviewers identified full-thickness retears with a moderate to good degree of inter-rater agreement in all evaluations, at both 6 months (κ = 0.42 to 0.73) and 24 months (κ = 0.61 to 0.80) after ARCR. However, poor inter-rater agreement (κ = 0.13 to 0.19) was found in the identification of partial-thickness retears in all evaluations at 6 months after ARCR.

      Conclusions

      Shoulder surgeons showed better intra- and inter-rater agreement in predicting full-thickness tears compared with partial-thickness tears. The inter-rater agreement at 24 months after ARCR was superior to that at 6 months in predicting not only full-thickness retear but also partial-thickness retear. MRI evaluation of rotator cuff integrity at 6 months after ARCR may be less reliable, regardless of which classification system is used.

      Level of Evidence

      Level III, retrospective comparative study.
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      References

        • Mihata T.
        • Watanabe C.
        • Fukunishi K.
        • et al.
        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. 2011; 39: 2091-2098
        • Sugaya H.
        • Maeda K.
        • Matsuki K.
        • Moriishi J.
        Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study.
        J Bone Joint Surg Am. 2007; 89: 953-960
        • Boileau P.
        • Brassart N.
        • Watkinson D.J.
        • Carles M.
        • Hatzidakis A.M.
        • Krishnan S.G.
        Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?.
        J Bone Joint Surg Am. 2005; 87: 1229-1240
        • Harryman 2nd, D.T.
        • Mack L.A.
        • Wang K.Y.
        • Jackins S.E.
        • Richardson M.L.
        • Matsen 3rd, F.A.
        Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff.
        J Bone Joint Surg Am. 1991; 73: 982-989
        • Gazielly D.F.
        • Gleyze P.
        • Montagnon C.
        Functional and anatomical results after rotator cuff repair.
        Clin Orthop Relat Res. 1994; : 43-53
        • Thomazeau H.
        • Boukobza E.
        • Morcet N.
        • Chaperon J.
        • Langlais F.
        Prediction of rotator cuff repair results by magnetic resonance imaging.
        Clin Orthop Relat Res. 1997; : 275-283
        • Gerber C.
        • Fuchs B.
        • Hodler J.
        The results of repair of massive tears of the rotator cuff.
        J Bone Joint Surg Am. 2000; 82: 505-515
        • Galatz L.M.
        • Ball C.M.
        • Teefey S.A.
        • Middleton W.D.
        • Yamaguchi K.
        The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.
        J Bone Joint Surg Am. 2004; 86: 219-224
        • Liu S.H.
        • Baker C.L.
        Arthroscopically assisted rotator cuff repair: Correlation of functional results with integrity of the cuff.
        Arthroscopy. 1994; 10: 54-60
        • Jost B.
        • Pfirrmann C.W.
        • Gerber C.
        • Switzerland Z.
        Clinical outcome after structural failure of rotator cuff repairs.
        J Bone Joint Surg Am. 2000; 82: 304-314
        • Park M.C.
        • Elattrache N.S.
        • Ahmad C.S.
        • Tibone J.E.
        “Transosseous-equivalent” rotator cuff repair technique.
        Arthroscopy. 2006; 22: 1360.e1-1360.e5
        • Park M.C.
        • Tibone J.E.
        • ElAttrache N.S.
        • Ahmad C.S.
        • Jun B.J.
        • Lee T.Q.
        Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.
        J Shoulder Elbow Surg. 2007; 16: 469-476
        • Mihata T.
        • Fukuhara T.
        • Jun B.J.
        • Watanabe C.
        • Kinoshita M.
        Effect of shoulder abduction angle on biomechanical properties of the repaired rotator cuff tendons with 3 types of double-row technique.
        Am J Sports Med. 2011; 39: 551-556
        • Owen R.S.
        • Iannotti J.P.
        • Kneeland J.B.
        • Dalinka M.K.
        • Deren J.A.
        • Oleaga L.
        Shoulder after surgery: MR imaging with surgical validation.
        Radiology. 1993; 186: 443-447
        • Sugaya H.
        • Maeda K.
        • Matsuki K.
        • Moriishi J.
        Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.
        Arthroscopy. 2005; 21: 1307-1316
        • Hayashida K.
        • Tanaka M.
        • Koizumi K.
        • Kakiuchi M.
        Characteristic retear patterns assessed by magnetic resonance imaging after arthroscopic double-row rotator cuff repair.
        Arthroscopy. 2012; 28: 458-464
        • Burks R.T.
        • Crim J.
        • Brown N.
        • Fink B.
        • Greis P.E.
        A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: Magnetic resonance imaging and early clinical evaluation.
        Am J Sports Med. 2009; 37: 674-682
        • Balich S.M.
        • Sheley R.C.
        • Brown T.R.
        • Sauser D.D.
        • Quinn S.F.
        MR imaging of the rotator cuff tendon: Interobserver agreement and analysis of interpretive errors.
        Radiology. 1997; 204: 191-194
        • Robertson P.L.
        • Schweitzer M.E.
        • Mitchell D.G.
        • et al.
        Rotator cuff disorders: Interobserver and intraobserver variation in diagnosis with MR imaging.
        Radiology. 1995; 194: 831-835
        • Singson R.D.
        • Hoang T.
        • Dan S.
        • Friedman M.
        MR evaluation of rotator cuff pathology using T2-weighted fast spin-echo technique with and without fat suppression.
        AJR Am J Roentgenol. 1996; 166: 1061-1065
        • Spencer Jr., E.E.
        • Dunn W.R.
        • Wright R.W.
        • et al.
        Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging.
        Am J Sports Med. 2008; 36: 99-103
        • Teefey S.A.
        • Rubin D.A.
        • Middleton W.D.
        • Hildebolt C.F.
        • Leibold R.A.
        • Yamaguchi K.
        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. 2004; 86: 708-716
        • Grant J.A.
        • Miller B.S.
        • Jacobson J.A.
        • et al.
        Intra- and inter-rater reliability of the detection of tears of the supraspinatus central tendon on MRI by shoulder surgeons.
        J Shoulder Elbow Surg. 2013; 22: 725-731
        • Iannotti J.P.
        • Deutsch A.
        • Green A.
        • et al.
        Time to failure after rotator cuff repair: a prospective imaging study.
        J Bone Joint Surg Am. 2013; 95: 965-971
        • Cho N.S.
        • Yi J.W.
        • Lee B.G.
        • Rhee Y.G.
        Retear patterns after arthroscopic rotator cuff repair: Single-row versus suture bridge technique.
        Am J Sports Med. 2010; 38: 664-671
        • Crim J.
        • Burks R.
        • Manaster B.J.
        • Hanrahan C.
        • Hung M.
        • Greis P.
        Temporal evolution of MRI findings after arthroscopic rotator cuff repair.
        AJR Am J Roentgenol. 2010; 195: 1361-1366
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Khazzam M.
        • Kuhn J.E.
        • Mulligan E.
        • et al.
        Magnetic resonance imaging identification of rotator cuff retears after repair: Interobserver and intraobserver agreement.
        Am J Sports Med. 2012; 40: 1722-1727
        • Gusmer P.B.
        • Potter H.G.
        • Donovan W.D.
        • O'Brien S.J.
        MR imaging of the shoulder after rotator cuff repair.
        AJR Am J Roentgenol. 1997; 168: 559-563
        • Iannotti J.P.
        • Zlatkin M.B.
        • Esterhai J.L.
        • Kressel H.Y.
        • Dalinka M.K.
        • Spindler K.P.
        Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value.
        J Bone Joint Surg Am. 1991; 73: 17-29
        • Quinn S.F.
        • Sheley R.C.
        • Demlow T.A.
        • Szumowski J.
        Rotator cuff tendon tears: evaluation with fat-suppressed MR imaging with arthroscopic correlation in 100 patients.
        Radiology. 1995; 195: 497-500
        • Reinus W.R.
        • Shady K.L.
        • Mirowitz S.A.
        • Totty W.G.
        MR diagnosis of rotator cuff tears of the shoulder: Value of using T2-weighted fat-saturated images.
        AJR Am J Roentgenol. 1995; 164: 1451-1455
        • Ferrari F.S.
        • Governi S.
        • Burresi F.
        • Vigni F.
        • Stefani P.
        Supraspinatus tendon tears: Comparison of US and MR arthrography with surgical correlation.
        Eur Radiol. 2002; 12: 1211-1217
        • Toyoda H.
        • Ito Y.
        • Tomo H.
        • Nakao Y.
        • Koike T.
        • Takaoka K.
        Evaluation of rotator cuff tears with magnetic resonance arthrography.
        Clin Orthop Relat Res. 2005; 439: 109-115
        • de Jesus J.O.
        • Parker L.
        • Frangos A.J.
        • Nazarian L.N.
        Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: A meta-analysis.
        AJR Am J Roentgenol. 2009; 192: 1701-1707