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Assessment of Tendon Retraction in Large to Massive Rotator Cuff Tears: A Modified Patte Classification Based on 2 Coronal Sections on Preoperative Magnetic Resonance Imaging With Higher Specificity on Predicting Reparability

      Purpose

      To propose a modified Patte classification (evaluating tendon retraction on 2 coronal sections) and analyze whether this classification was better at predicting irreparability and retear of large to massive rotator cuff tears (RCTs).

      Methods

      A retrospective study was performed. Imaging evaluation including tendon retraction, fatty infiltration, the acromiohumeral distance (AHD), and the tangent sign was performed using magnetic resonance imaging. The modified Patte classification was used to assess tendon retraction. Intraobserver and interobserver reliability was analyzed by calculating intraclass correlation coefficients. Factors affecting irreparability and retear were analyzed using both univariate and multivariate analyses. Sensitivity and specificity of tendon retraction to predict irreparability and retear were calculated.

      Results

      A total of 121 shoulders with large to massive RCTs underwent arthroscopic rotator cuff repairs. The modified Patte classification system had excellent interobserver and intraobserver reliability. Several factors were associated with reparability and retear in the univariate analysis. However, in binary logistic regression analysis, the only factors affecting reparability were AHD less than 0.4 cm (P = .007) and modified Patte stage III tendon retraction (P = .023). Low-grade repair quality (P = .001) and modified Patte stage III tendon retraction (P = .031) were independent factors for retear. Modified Patte stage III had a high specificity for predicting irreparability (93.58%) and retear (98.78%), whereas the specificity of original Patte stage III was 76.15% and 84.15%, respectively.

      Conclusions

      For large to massive RCT repairs, modified Patte stage III tendon retraction with evaluation of 2 coronal cuts reveals higher specificity on predicting tendon irreparability and postoperative retear. An AHD less than 0.4 cm on magnetic resonance imaging and modified Patte stage III tendon retraction were independent risk factors for irreparability. Low-grade repair quality and modified Patte stage III tendon retraction were independent risk factors for postoperative retear.

      Level of Evidence

      Level III, case-control study.
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      References

        • Bedi A.
        • Fox A.J.
        • Harris P.E.
        • et al.
        Diabetes mellitus impairs tendon-bone healing after rotator cuff repair.
        J Shoulder Elbow Surg. 2010; 19: 978-988
        • Henry P.
        • Wasserstein D.
        • Park S.
        • et al.
        Arthroscopic repair for chronic massive rotator cuff tears: A systematic review.
        Arthroscopy. 2015; 31: 2472-2480
        • 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-A: 219-224
        • Chung S.W.
        • Kim J.Y.
        • Kim M.H.
        • Kim S.H.
        • Oh J.H.
        Arthroscopic repair of massive rotator cuff tears: Outcome and analysis of factors associated with healing failure or poor postoperative function.
        Am J Sports Med. 2013; 41: 1674-1683
        • Miller B.S.
        • Downie B.K.
        • Kohen R.B.
        • et al.
        When do rotator cuff repairs fail? Serial ultrasound examination after arthroscopic repair of large and massive rotator cuff tears.
        Am J Sports Med. 2011; 39: 2064-2070
        • Kim J.R.
        • Cho Y.S.
        • Ryu K.J.
        • Kim J.H.
        Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: Assessment of repair integrity on magnetic resonance imaging.
        Am J Sports Med. 2012; 40: 786-793
        • Park J.Y.
        • Lhee S.H.
        • Oh K.S.
        • Moon S.G.
        • Hwang J.T.
        Clinical and ultrasonographic outcomes of arthroscopic suture bridge repair for massive rotator cuff tear.
        Arthroscopy. 2013; 29: 280-289
        • Saccomanno M.F.
        • Sircana G.
        • Cazzato G.
        • Donati F.
        • Randelli P.
        • Milano G.
        Prognostic factors influencing the outcome of rotator cuff repair: A systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3809-3819
        • Sheean A.J.
        • Hartzler R.U.
        • Denard P.J.
        • et al.
        Preoperative radiographic risk factors for incomplete arthroscopic supraspinatus tendon repair in massive rotator cuff tears.
        Arthroscopy. 2018; 34: 1121-1127
        • Yoo J.C.
        • Ahn J.H.
        • Yang J.H.
        • Koh K.H.
        • Choi S.H.
        • Yoon Y.C.
        Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans.
        Arthroscopy. 2009; 25: 573-582
        • Lambers Heerspink F.O.
        • Dorrestijn O.
        • van Raay J.J.
        • Diercks R.L.
        Specific patient-related prognostic factors for rotator cuff repair: A systematic review.
        J Shoulder Elbow Surg. 2014; 23: 1073-1080
        • Chung S.W.
        • Oh J.H.
        • Gong H.S.
        • Kim J.Y.
        • Kim S.H.
        Factors affecting rotator cuff healing after arthroscopic repair: Osteoporosis as one of the independent risk factors.
        Am J Sports Med. 2011; 39: 2099-2107
        • Dwyer T.
        • Razmjou H.
        • Henry P.
        • Gosselin-Fournier S.
        • Holtby R.
        Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 415-422
        • Oh J.H.
        • Kim S.H.
        • Ji H.M.
        • Jo K.H.
        • Bin S.W.
        • Gong H.S.
        Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome.
        Arthroscopy. 2009; 25: 30-39
        • 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
        • Djahangiri A.
        • Cozzolino A.
        • Zanetti M.
        • et al.
        Outcome of single-tendon rotator cuff repair in patients aged older than 65 years.
        J Shoulder Elbow Surg. 2013; 22: 45-51
        • Lee K.W.
        • Seo D.W.
        • Bae K.W.
        • Choy W.S.
        Clinical and radiological evaluation after arthroscopic rotator cuff repair using suture bridge technique.
        Clin Orthop Surg. 2013; 5: 306-313
        • Lichtenberg S.
        • Liem D.
        • Magosch P.
        • Habermeyer P.
        Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: A prospective, MRI controlled study.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 1200-1206
        • Lippe J.
        • Spang J.T.
        • Leger R.R.
        • Arciero R.A.
        • Mazzocca A.D.
        • Shea K.P.
        Inter-rater agreement of the Goutallier, Patte, and Warner classification scores using preoperative magnetic resonance imaging in patients with rotator cuff tears.
        Arthroscopy. 2012; 28: 154-159
        • Meyer D.C.
        • Farshad M.
        • Amacker N.A.
        • Gerber C.
        • Wieser K.
        Quantitative analysis of muscle and tendon retraction in chronic rotator cuff tears.
        Am J Sports Med. 2012; 40: 606-610
        • Patte D.
        Classification of rotator cuff lesions.
        Clin Orthop Relat Res. 1990; 254: 81-86
        • Fuchs B.
        • Weishaupt D.
        • Zanetti M.
        • Hodler J.
        • Gerber C.
        Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging.
        J Shoulder Elbow Surg. 1999; 8: 599-605
        • Goutallier D.
        • Postel J.M.
        • Van Driessche S.
        • Godefroy D.
        • Radier C.
        Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: Results in a prospective series with limited fatty muscular degeneration.
        J Shoulder Elbow Surg. 2006; 15: 164-172
        • Goutallier D.
        • Postel J.-M.
        • Gleyze P.
        • Leguilloux P.
        • Van Driessche S.
        Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.
        J Shoulder Elbow Surg. 2003; 12: 550-554
        • Zanetti M.
        • Gerber C.
        • Hodler J.
        Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging.
        Invest Radiol. 1998; 33: 163-170
        • Burkhart S.S.
        • Athanasiou K.A.
        • Wirth M.A.
        Margin convergence: A method of reducing strain in massive rotator cuff tears.
        Arthroscopy. 1996; 12: 335-338
        • Deutsch A.
        • Altchek D.W.
        • Schwartz E.
        • Otis J.C.
        • Warren R.F.
        Radiologic measurement of superior displacement of the humeral head in the impingement syndrome.
        J Shoulder Elbow Surg. 1996; 5: 186-193
        • McCreesh K.M.
        • Crotty J.M.
        • Lewis J.S.
        Acromiohumeral distance measurement in rotator cuff tendinopathy: Is there a reliable, clinically applicable method? A systematic review.
        Br J Sports Med. 2015; 49: 298-305
        • Saupe N.
        • Pfirrmann C.W.
        • Schmid M.R.
        • Jost B.
        • Werner C.M.
        • Zanetti M.
        Association between rotator cuff abnormalities and reduced acromiohumeral distance.
        AJR Am J Roentgenol. 2006; 187: 376-382
        • Werner C.M.
        • Conrad S.J.
        • Meyer D.C.
        • Keller A.
        • Hodler J.
        • Gerber C.
        Intermethod agreement and interobserver correlation of radiologic acromiohumeral distance measurements.
        J Shoulder Elbow Surg. 2008; 17: 237-240
        • Goutallier D.
        • Le Guilloux P.
        • Postel J.M.
        • Radier C.
        • Bernageau J.
        • Zilber S.
        Acromio humeral distance less than six millimeter: Its meaning in full-thickness rotator cuff tear.
        Orthop Traumatol Surg Res. 2011; 97: 246-251