Purpose
To investigate the intra- and inter-rater agreements for magnetic resonance imaging
(MRI) evaluations of subscapularis tendon integrity at 6 months after arthroscopic
rotator cuff repairs.
Methods
Patients who had isolated or combined subscapularis tears and had undergone arthroscopic
rotator cuff repairs were retrospectively included. The exclusion criteria included
revision of arthroscopic surgery, minor subscapularis tears without repair, and inadequate
postoperative images. MRI scans 6 months after surgery were used for the purpose of
accessing the integrity of the subscapularis tendons. Three orthopaedic surgeons blindly
evaluated the images twice at 2-week intervals. Three currently available classifications
were used: the Owen classification, the Sugaya classification, and the Hayashida classification.
Dichotomization and trichotomization methods were used for the Sugaya classification
and Hayashida classifications. The aforementioned classification scores were combined
for the agreement evaluation. Intra- and inter-rater agreement was assessed by calculating
the Fleiss’ kappa coefficients.
Results
A total of 35 patients were included. Both the Owen and Hayashida classifications
had poor inter-rater agreements (κ = 0.10 and 0.04, respectively) and poor-to-weak
intra-rater agreements (κ = 0.27-0.44 and 0.16-0.45, respectively). The Sugaya classification
had poor inter-rater agreement (κ = 0.10) and poor intra-rater agreements (κ = 0.16-0.32).
Dichotomization and trichotomization of Sugaya and Hayashida classifications did not
lead to superior agreements. The classification combination resulted in poor inter-
and intra-rater agreements (κ = 0.01-0.12 and 0.08-0.39, respectively).
Conclusions
The Owen classification, Sugaya classification, and Hayashida classification had poor
intra- and inter-rater agreement in terms of evaluating subscapularis tendon re-tears
on 6 months’ postoperative MRI. The dichotomized and trichotomized classifications
as well as the combined classifications from currently available classifications did
not lead to superior agreements.
Level of Evidence
Level IV, diagnostic: case series.
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References
- Time to failure after rotator cuff repair: A prospective imaging study.J Bone Joint Surg Am. 2013; 95: 965-971
- 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
- Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair?.Arthroscopy. 2010; 26: 393-403
- Post-operative rotator cuff integrity, based on Sugaya's classification, can reflect abduction muscle strength of the shoulder.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 161-168
Yuri T, Mura N, Hoshikawa K, Giambini H, Fujii H, Kiyoshige Y. Influence of fat infiltration, tear size, and postoperative tendon integrity on muscle contractility of repaired supraspinatus muscle [published online June 19, 2021]. Eur J Orthop Surg Traumatol. doi:10.1007/s00590-021-03020-1
- Combined subscapularis tears in massive posterosuperior rotator cuff tears: Do they affect postoperative shoulder function and rotator cuff integrity?.Am J Sports Med. 2016; 44: 183-190
- Subscapularis re-tears associated with preoperative advanced fatty infiltration and greater subscapularis involvement, leading to inferior functional outcomes and decreased acromiohumeral distance.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 2624-2630
- Repair failure increases the risk of developing secondary glenohumeral osteoarthritis: A long-term follow-up after open repair of large subscapularis tendon tears.Orthop Traumatol Surg Res. 2019; 105: 1529-1533
- Characteristic retear patterns assessed by magnetic resonance imaging after arthroscopic double-row rotator cuff repair.Arthroscopy. 2012; 28: 458-464
- Shoulder after surgery: MR imaging with surgical validation.Radiology. 1993; 186: 443-447
- Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.Arthroscopy. 2005; 21: 1307-1316
- Intra- and inter-rater agreement on magnetic resonance imaging evaluation of rotator cuff integrity after repair.Arthroscopy. 2016; 32: 2451-2458
- Inter-rater agreement of rotator cuff tendon and muscle magnetic resonance imaging parameters evaluated preoperatively and during the first postoperative year following rotator cuff repair.J Shoulder Elbow Surg. 2021; 30: e741-e752
- Statistics from A (agreement) to Z (z score): A guide to interpreting common measures of association, agreement, diagnostic accuracy, effect size, heterogeneity, and reliability in medical research.Anesth Analg. 2021; 133: 1633-1641
- 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
- Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: A systematic review and meta-analysis.Br J Sports Med. 2015; 49: 1316-1328
- Autologous conditioned plasma for tendon healing following arthroscopic rotator cuff repair. Prospective comparative assessment with magnetic resonance arthrography at 6 months' follow-up.Orthop Traumatol Surg Res. 2019; 105: 245-249
- Intra-articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re-tear rate after arthroscopic rotator cuff repair.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3912-3919
- Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 154-161
- Nontendinous healing after repairing of retracted rotator cuff tear: An imaging study.J Shoulder Elbow Surg. 2021; 30: 2560-2569
Article info
Publication history
Published online: December 14, 2021
Accepted:
December 1,
2021
Received:
August 12,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: Funded by National Cheng Kung University Hospital, Tainan, Taiwan (NCKUH-11002049). Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Primary study institution: Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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© 2021 by the Arthroscopy Association of North America
