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Liu MM, Chen X, Yu CW, Chen JW, Zhen PX, Liu ZP. A causal association between lipid-lowering medications and rotator cuff syndrome: a drug-targeted mendelian randomization study. Front Genet 2024; 15:1383646. [PMID: 38903760 PMCID: PMC11187090 DOI: 10.3389/fgene.2024.1383646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Background: Previous research has suggested that dyslipidemia may be a risk factor for rotator cuff syndrome (RCS), and lipid-lowering drugs may aid in its treatment, though conclusions have not been definitive. Mendelian randomization is a statistical method that explores the causal relationships between exposure factors and diseases. It overcomes the confounding issues inherent in traditional observational studies, thereby providing more reliable causal inferences. We employed this method to investigate whether hyperlipidemia is a risk factor for rotator cuff syndrome and whether lipid-lowering drugs can effectively treat this condition. Methods: Genetic variations linked to lipid traits low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and total cholesterol (TC) were acquired from the UK Biobank and the Global Lipids Genetics Consortium (GLGC). Data on genetic variation in rotator cuff syndrome were obtained from FinnGen, including 24,061 patients and 275,212 controls. In the next step, we carried out two-sample Mendelian randomization analyses to determine whether lipid traits correlate with rotator cuff syndrome risk. Additionally, we performed drug-target Mendelian randomization (MR) analyses on 10 drug targets related to rotator cuff syndrome. For the drug targets that showed significant results, further analysis was done using Summary-data-based Mendelian Randomization (SMR) and colocalization techniques. We performed a mediation analysis to identify potential mediators between HMG-CoA reductase (HMGCR) and RCS. Results: No causative link was established between these lipid traits and rotator cuff syndrome. However, a significant association has been identified where HMGCR inhibition corresponds to a reduced risk of rotator cuff disease (OR = 0.68, [95% CI, 0.56-0.83], p = 1.510 × 10-4). Additionally, enhanced expression of HMGCR in muscle tissues is also linked to a decreased risk of rotator cuff syndrome (OR = 0.88, [95% CI, 0.76-0.99], p = 0.03). Body mass index (BMI) mediated 22.97% of the total effect of HMGCR on RCS. Conclusion: This study does not support low-density LDL-C, TG, and TC as risk factors for rotator cuff syndrome. HMGCR represents a potential pharmaceutical target for preventing and treating rotator cuff syndrome. The protective action of statins on the rotator cuff syndrome might not be associated with their lipid-lowering properties.
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Affiliation(s)
- Meng-meng Liu
- School of Physical Education and Health, Guangxi Medical University, Nanning, China
| | - Xiang Chen
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chuan-wen Yu
- School of Physical Education and Health, Heze University, Heze, China
| | - Jin-wei Chen
- Department of Physical Education, Dongshin University, Naju, Republic of Korea
| | - Pu-xiang Zhen
- National Demonstration Center for Experimental (General Practice) Education, Hubei University of Science and Technology, Xianning, China
| | - Zhi-peng Liu
- Division of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Ni M, Zhao Y, Zhang L, Chen W, Wang Q, Tian C, Yuan H. MRI-based automated multitask deep learning system to evaluate supraspinatus tendon injuries. Eur Radiol 2024; 34:3538-3551. [PMID: 37964049 DOI: 10.1007/s00330-023-10392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/01/2023] [Accepted: 09/08/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To establish an automated, multitask, MRI-based deep learning system for the detailed evaluation of supraspinatus tendon (SST) injuries. METHODS According to arthroscopy findings, 3087 patients were divided into normal, degenerative, and tear groups (groups 0-2). Group 2 was further divided into bursal-side, articular-side, intratendinous, and full-thickness tear groups (groups 2.1-2.4), and external validation was performed with 573 patients. Visual geometry group network 16 (VGG16) was used for preliminary image screening. Then, the rotator cuff multitask learning (RC-MTL) model performed multitask classification (classifiers 1-4). A multistage decision model produced the final output. Model performance was evaluated by receiver operating characteristic (ROC) curve analysis and calculation of related parameters. McNemar's test was used to compare the differences in the diagnostic effects between radiologists and the model. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 indicated statistical significance. RESULTS In the in-group dataset, the area under the ROC curve (AUC) of VGG16 was 0.92, and the average AUCs of RC-MTL classifiers 1-4 were 0.99, 0.98, 0.97, and 0.97, respectively. The average AUC of the automated multitask deep learning system for groups 0-2.4 was 0.98 and 0.97 in the in-group and out-group datasets, respectively. The ICCs of the radiologists were 0.97-0.99. The automated multitask deep learning system outperformed the radiologists in classifying groups 0-2.4 in both the in-group and out-group datasets (p < 0.001). CONCLUSION The MRI-based automated multitask deep learning system performed well in diagnosing SST injuries and is comparable to experienced radiologists. CLINICAL RELEVANCE STATEMENT Our study established an automated multitask deep learning system to evaluate supraspinatus tendon (SST) injuries and further determine the location of SST tears. The model can potentially improve radiologists' diagnostic efficiency, reduce diagnostic variability, and accurately assess SST injuries. KEY POINTS • A detailed classification of supraspinatus tendon tears can help clinical decision-making. • Deep learning enables the detailed classification of supraspinatus tendon injuries. • The proposed automated multitask deep learning system is comparable to radiologists.
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Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - Lihua Zhang
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - Qizheng Wang
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China
| | - Chunyan Tian
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China.
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, Haidian District, Beijing, People's Republic of China.
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Santilli G, Vetrano M, Mangone M, Agostini F, Bernetti A, Coraci D, Paoloni M, de Sire A, Paolucci T, Latini E, Santoboni F, Nusca SM, Vulpiani MC. Predictive Prognostic Factors in Non-Calcific Supraspinatus Tendinopathy Treated with Focused Extracorporeal Shock Wave Therapy: An Artificial Neural Network Approach. Life (Basel) 2024; 14:681. [PMID: 38929665 PMCID: PMC11205102 DOI: 10.3390/life14060681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
The supraspinatus tendon is one of the most involved tendons in the development of shoulder pain. Extracorporeal shockwave therapy (ESWT) has been recognized as a valid and safe treatment. Sometimes the symptoms cannot be relieved, or a relapse develops, affecting the patient's quality of life. Therefore, a prediction protocol could be a powerful tool aiding our clinical decisions. An artificial neural network was run, in particular a multilayer perceptron model incorporating input information such as the VAS and Constant-Murley score, administered at T0 and at T1 after six months. It showed a model sensitivity of 80.7%, and the area under the ROC curve was 0.701, which demonstrates good discrimination. The aim of our study was to identify predictive factors for minimal clinically successful therapy (MCST), defined as a reduction of ≥40% in VAS score at T1 following ESWT for chronic non-calcific supraspinatus tendinopathy (SNCCT). From the male gender, we expect greater and more frequent clinical success. The more severe the patient's initial condition, the greater the possibility that clinical success will decrease. The Constant and Murley score, Roles and Maudsley score, and VAS are not just evaluation tools to verify an improvement; they are also prognostic factors to be taken into consideration in the assessment of achieving clinical success. Due to the lower clinical improvement observed in older patients and those with worse clinical and functional scales, it would be preferable to also provide these patients with the possibility of combined treatments. The ANN predictive model is reasonable and accurate in studying the influence of prognostic factors and achieving clinical success in patients with chronic non-calcific tendinopathy of the supraspinatus treated with ESWT.
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Affiliation(s)
- Gabriele Santilli
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Andrea Bernetti
- Department of Biological and Environmental Science and Technologies, University of Salento, 73100 Lecce, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padua, 35122 Padua, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Teresa Paolucci
- Department of Oral Medical Science and Biotechnology, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Eleonora Latini
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Flavia Santoboni
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Sveva Maria Nusca
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
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Zhao Y, Qiu J, Li Y, Khan MA, Wan L, Chen L. Machine-learning models for diagnosis of rotator cuff tears in osteoporosis patients based on anteroposterior X-rays of the shoulder joint. SLAS Technol 2024:100149. [PMID: 38796035 DOI: 10.1016/j.slast.2024.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/01/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE This study aims to diagnose Rotator Cuff Tears (RCT) and classify the severity of RCT in patients with Osteoporosis (OP) through the analysis of shoulder joint anteroposterior (AP) X-ray-based localized proximal humeral bone mineral density (BMD) measurements and clinical information based on machine learning (ML) models. METHODS A retrospective cohort of 89 patients was analyzed, including 63 with both OP and RCT (OPRCT) and 26 with OP only. The study analyzed a series of shoulder radiographs from April 2021 to April 2023. Grayscale values were measured after plotting ROIs based on AP X-rays of shoulder joint. Five kinds of ML models were developed and compared based on their performance in predicting the occurrence and severity of RCT from ROIs' greyscale values and clinical information (age, gender, advantage side, lumbar BMD, and acromion morphology (AM)). Further analysis using SHAP values illustrated the significant impact of selected features on model predictions. RESULTS R1-6 had a positive correlation with BMD respectively. The nine variables, including greyscale R1-6, age, BMD, and AM, were used in the prediction models. The RF model was determined to be superior in effectively diagnosing RCT in OP patients, with high AUC scores of 0.998, 0.889, and 0.95 in the training, validation, and testing sets, respectively. SHAP values revealed that the most influential factors on the diagnostic outcomes were the grayscale values of all cancellous bones in ROIs. A column-line graph prediction model based on nine variables was constructed, and DCA curves indicated that RCT prediction in OP patients was favored based on this model. Furthermore, the RF model was also the most superior in predicting the types of RCT within the OPRCT group, with an accuracy of 86.364% and 73.684% in the training and test sets, respectively. SHAP values indicated that the most significant factor affecting the predictive outcomes was the AM, followed by the grayscale values of the greater tubercle, among others. CONCLUSIONS ML models, particularly the RF algorithm, show significant promise in diagnosing RCT occurrence and severity in OP patients using conventional shoulder X-rays based on the nine variables. This method presents a cost-effective, accessible, and non-invasive diagnostic strategy that has the potential to substantially enhance the early detection and management of RCT in OP patient population.
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Affiliation(s)
- Yu Zhao
- Postgraduate College, Guangzhou University of Chinese Medicine, Guangzhou 510080, China
| | - Jingjing Qiu
- Shenzhen Bao'an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518100, China; Postgraduate College, Guangzhou University of Chinese Medicine, Guangzhou 510080, China
| | - Yang Li
- College of Mechanical and Electrical Engineering, Shihezi University, Shihezi 832003, China
| | - Muhammad Attique Khan
- Department of Computer Science and Mathematics, Lebanese American University, Beirut, Lebanon
| | - Lei Wan
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
| | - Lihua Chen
- Shenzhen Bao'an Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen 518100, China; Postgraduate College, Guangzhou University of Chinese Medicine, Guangzhou 510080, China.
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Duhig SJ, McKenzie AK. Sound of synergy: ultrasound and artificial intelligence in sports medicine. Br J Sports Med 2024:bjsports-2023-108024. [PMID: 38697623 DOI: 10.1136/bjsports-2023-108024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Steven John Duhig
- School of Health Sciences and Social Work, Griffith University, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
| | - Alec Kenneth McKenzie
- School of Health Sciences and Social Work, Griffith University, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
- Sports Performance Innovation and Knowledge Excellence (SPIKE), Queensland Academy of Sport, Nathan, Queensland, Australia
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Iio R, Ueda D, Matsumoto T, Manaka T, Nakazawa K, Ito Y, Hirakawa Y, Yamamoto A, Shiba M, Nakamura H. Deep learning-based screening tool for rotator cuff tears on shoulder radiography. J Orthop Sci 2024; 29:828-834. [PMID: 37236873 DOI: 10.1016/j.jos.2023.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/06/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Early diagnosis of rotator cuff tears is essential for appropriate and timely treatment. Although radiography is the most used technique in clinical practice, it is difficult to accurately rule out rotator cuff tears as an initial imaging diagnostic modality. Deep learning-based artificial intelligence has recently been applied in medicine, especially diagnostic imaging. This study aimed to develop a deep learning algorithm as a screening tool for rotator cuff tears based on radiography. METHODS We used 2803 shoulder radiographs of the true anteroposterior view to develop the deep learning algorithm. Radiographs were labeled 0 and 1 as intact or low-grade partial-thickness rotator cuff tears and high-grade partial or full-thickness rotator cuff tears, respectively. The diagnosis of rotator cuff tears was determined based on arthroscopic findings. The diagnostic performance of the deep learning algorithm was assessed by calculating the area under the curve (AUC), sensitivity, negative predictive value (NPV), and negative likelihood ratio (LR-) of test datasets with a cutoff value of expected high sensitivity determination based on validation datasets. Furthermore, the diagnostic performance for each rotator cuff tear size was evaluated. RESULTS The AUC, sensitivity, NPV, and LR- with expected high sensitivity determination were 0.82, 84/92 (91.3%), 102/110 (92.7%), and 0.16, respectively. The sensitivity, NPV, and LR- for full-thickness rotator cuff tears were 69/73 (94.5%), 102/106 (96.2%), and 0.10, respectively, while the diagnostic performance for partial-thickness rotator cuff tears was low at 15/19 (78.9%), NPV of 102/106 (96.2%) and LR- of 0.39. CONCLUSIONS Our algorithm had a high diagnostic performance for full-thickness rotator cuff tears. The deep learning algorithm based on shoulder radiography helps screen rotator cuff tears by setting an appropriate cutoff value. LEVEL OF EVIDENCE Level III: Diagnostic Study.
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Affiliation(s)
- Ryosuke Iio
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daiju Ueda
- Smart Life Science Lab, Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan; Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Toshimasa Matsumoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tomoya Manaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
| | - Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan; Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yoichi Ito
- Ito Clinic, Osaka Shoulder Center, Osaka, Japan
| | - Yoshihiro Hirakawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akira Yamamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Masatsugu Shiba
- Smart Life Science Lab, Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan; Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Toh Y. Ultrasound Versus Magnetic Resonance Imaging as First-Line Imaging Strategies for Rotator Cuff Pathologies: A Comprehensive Analysis of Clinical Practices, Economic Efficiency, and Future Perspectives. Cureus 2024; 16:e59231. [PMID: 38813323 PMCID: PMC11132969 DOI: 10.7759/cureus.59231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
Rotator cuff injuries are a prevalent cause of atraumatic chronic shoulder pain, imposing a significant healthcare burden. This article reviews the clinical presentation, diagnostic imaging modalities, practice variations, and economic efficiency considerations in the evaluation of rotator cuff pathologies. Ultrasound (US) and magnetic resonance imaging (MRI) are the primary imaging methods for diagnosing rotator cuff injuries. US provides real-time visualization but has limited tissue penetration, while MRI offers detailed anatomical information but is not a dynamic process. Studies show that MRI is superior to US with higher sensitivity and specificity. MRI is the gold standard, particularly for surgical planning, but US remains relevant when MRI is not feasible. Both require standardized protocols for evaluating tear dimensions and muscle atrophy. With the operator-dependent nature of US, MRI offers a more comprehensive assessment of rotator cuff tears and predictive insights for clinical outcomes. Practice variations exist in the management of rotator cuff pathologies, with some countries favoring US as the primary imaging modality and others relying more on MRI. These variations are influenced by factors like resource availability and healthcare system nuances. In Australia, current guidelines lean toward conservative management, potentially leading to delayed diagnoses and increased costs. The United States often favors MRI, while Canada advocates for US as the initial choice. Economic considerations play a significant role in selecting imaging modalities. While US is cost-effective, it may necessitate subsequent MRI examinations, contributing to inefficiencies in the diagnostic process. Studies suggest that a combined approach of US and MRI is less efficient and cost-effective than MRI alone. However, the use of both modalities rather than MRI alone is common in clinical practice, adding to healthcare expenses. In conclusion, the choice of imaging modality for rotator cuff pathologies should consider factors such as diagnostic efficacy, cost-effectiveness, and resource availability. Radiologists play a pivotal role in guiding this selection and ensuring comprehensive evaluations. Future considerations should include the revision of management guidelines and the potential inclusion of shoulder pathologies in healthcare coverage to optimize patient care and healthcare expenditure.
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Affiliation(s)
- Yvana Toh
- Surgery, Surgical Treatment and Rehabilitation Service (STARS), Brisbane, AUS
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Dwivedi A, Sharma R, Sharma A, Gupta P. Evaluation of Shoulder Injuries: A Comparative Study of Imaging by Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography (MRA). JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1494-S1497. [PMID: 38882885 PMCID: PMC11174231 DOI: 10.4103/jpbs.jpbs_1104_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 06/18/2024] Open
Abstract
Background In contrast to the standard shoulder arthroscopy, current radio-diagnostic techniques like magnetic resonance arthrography (MRA), and magnetic resonance imaging (MRI) provide less invasive intricate structural detail of shoulder anatomy. Objectives Comparison of efficacy of MRA and MRI for diagnosing suspected rotator cuff injury. Materials and Methods Over the course of 4 years (from June 2017 to June 2021), a comparative study, including 100 individuals with suspected rotator cuff pathology, was conducted. For the evaluation of shoulder injuries, the assessment and comparison of MRA and MRI were done in terms of sensitivity (Sn), positive predictive value (PPV), and diagnostic accuracy (DA). Results MRI and MRA were positive in 76 (76%) and 98 (98%) patients, respectively. The Sn and PPV of MRI for diagnosing the shoulder injury were 76% and 100%, respectively, whereas the Sn and PPV of MRA were 98% and 100%, respectively. MRA was better than MRI in terms of diagnostic accuracy (98% vs. 76%, P = 0.03). Conclusion MRA is a nonsurgical effective method in evaluating and diagnosing rotator cuff injuries in comparison to MRI.
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Affiliation(s)
- Abhishek Dwivedi
- Department of Radiodiagnosis, FH Medical College and Hospital, Agra, Uttar Pradesh, India
| | - Rachit Sharma
- Department of Radiodiagnosis, Military Hospital, Jaipur, Rajasthan, India
| | - Ankur Sharma
- Department of Radiodiagnosis, FH Medical College and Hospital, Agra, Uttar Pradesh, India
| | - Pallav Gupta
- Department of Radiodiagnosis, FH Medical College and Hospital, Agra, Uttar Pradesh, India
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Winkler S, Herbst B, Kafchitsas K, Wohlmuth P, Hoffstetter P, Rueth MJ. Pre-operative Assessment of Shoulder Pathologies on MRI by a Radiologist and an Orthopaedic Surgeon. Malays Orthop J 2024; 18:42-50. [PMID: 38638663 PMCID: PMC11023335 DOI: 10.5704/moj.2403.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/03/2023] [Indexed: 04/20/2024] Open
Abstract
Introduction Pathologies of the shoulder, i.e. rotator cuff tears and labral injuries are very common. Most patients receive MRI examination prior to surgery. A correct assessment of pathologies is significant for a detailed patient education and planning of surgery. Materials and methods Sixty-nine patients were identified, who underwent both, a standardised shoulder MRI and following arthroscopic shoulder surgery in our hospital. For this retrospective comparative study, the MRIs were pseudonymised and evaluated separately by an orthopaedic surgeon and a radiologist. A third rater evaluated images and reports of shoulder surgery, which served as positive control. Results of all raters were then compared. The aim was an analysis of agreement rates of diagnostic accuracy of preoperative MRI by a radiologist and an orthopaedic surgeon. Results The overall agreement with positive control of detecting transmural cuff tears was high (84% and 89%) and lower for partial tears (70-80%). Subscapularis tears were assessed with moderate rates of agreement (60 - 70%) compared to intra-operative findings. Labral pathologies were detected mostly correctly. SLAP lesions and pulley lesions of the LHB were identified with only moderate agreement (66.4% and 57.2%) and had a high inter-rater disagreement. Conclusion This study demonstrated that tears of the rotator cuff (supraspinatus, infraspinatus) and labral pathologies can be assessed in non-contrast pre-operative shoulder MRI images with a high accuracy. This allows a detailed planning of surgery and aftercare. Pathologies of the subscapularis tendon, SLAP lesions and biceps instabilities are more challenging to detect correctly. There were only small differences between a radiologic and orthopaedic interpretation of the images.
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Affiliation(s)
- S Winkler
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - B Herbst
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - K Kafchitsas
- Department of Orthopaedic Surgery, Asklepios Hospital Lindenlohe, Schwandorf, Germany
| | - P Wohlmuth
- Department of Research, ASKLEPIOS Proresearch, Hamburg, Germany
| | - P Hoffstetter
- Department of Radiology, University of Regensburg, Regensburg, Germany
| | - M J Rueth
- Department Sports Clinic, Sportklinik Fichtelgebirge, Markredwitz, Germany
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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Kimball JS, Woodard D, Gulbrandsen MT, Jobe CM, Phipatanakul WP, Syed HM. Patients With Intact Shoulder Superior Capsular Reconstruction Grafts on Ultrasound Show Significant Improvement in Functional Outcomes at Minimum 2-Year Follow-up. Arthrosc Sports Med Rehabil 2024; 6:100857. [PMID: 38288033 PMCID: PMC10823090 DOI: 10.1016/j.asmr.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose To assess the utility of using dynamic ultrasound for postoperative evaluation after superior capsular reconstruction (SCR) by evaluating graft integrity and its correlation with clinical outcomes at a minimum 2-year follow-up. Methods A retrospective chart review was conducted to identify patients who underwent SCR between July 2015 and July 2020 with a minimum 2-year clinical and ultrasound follow-up. Clinical outcome measures included Simple Shoulder (SS) and American Shoulder and Elbow Surgeon (ASES) scores. Integrity of the SCR graft was evaluated by dynamic ultrasound. Results We evaluated 22 shoulders in 21 patients with a mean follow-up of 44.8 months (range, 24-71 months). The graft was found to be intact by ultrasound evaluation in 82% (18/22). Patients with intact grafts had higher mean SS (11.6 vs 7.8, P = .00079) and ASES (91.2 vs 64.1, P = .0296) scores at latest follow-up compared to those with failed grafts. Those with intact grafts also had significant improvement in SS (3.7 vs 11.6, P < .00001) and ASES (23.2 vs 91.2, P < .00001) scores at latest follow-up compared to their preoperative scores. In contrast, patients with graft failure had no significant improvement in SS (6.3 vs 9.0, P = .123) and ASES (40.4 vs 58.3, P = .05469) scores at latest follow-up compared to their preoperative scores. There was no difference between clinical outcomes at 6 to 12 months vs latest follow-up for both SS (P = .11, P = .5) and ASES (P = .27, P = .21) scores. Conclusions SCR grafts were found by ultrasound to be intact in 82% of cases. Patients with intact grafts on ultrasound had significant improvement in functional outcome scores while those with graft failure did not. Functional outcome scores suggest that maximal recovery from this procedure occurs by 6 to 12 months. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Jeff S. Kimball
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - David Woodard
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Matthew T. Gulbrandsen
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Christopher M. Jobe
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
- Veterans Administration Loma Linda, Loma Linda, California, U.S.A
| | - Wesley P. Phipatanakul
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Hasan M. Syed
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
- Veterans Administration Loma Linda, Loma Linda, California, U.S.A
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12
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Zhan H, Teng F, Liu Z, Yi Z, He J, Chen Y, Geng B, Xia Y, Wu M, Jiang J. Artificial Intelligence Aids Detection of Rotator Cuff Pathology: A Systematic Review. Arthroscopy 2024; 40:567-578. [PMID: 37355191 DOI: 10.1016/j.arthro.2023.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine the model performance of artificial intelligence (AI) in detecting rotator cuff pathology using different imaging modalities and to compare capability with physicians in clinical scenarios. METHODS The review followed the PRISMA guidelines and was registered on PROSPERO. The criteria were as follows: 1) studies on the application of AI in detecting rotator cuff pathology using medical images, and 2) studies on smart devices for assisting in diagnosis were excluded. The following data were extracted and recorded: statistical characteristics, input features, AI algorithms used, sample sizes of training and testing sets, and model performance. The data extracted from the included studies were narratively reviewed. RESULTS A total of 14 articles, comprising 23,119 patients, met the inclusion and exclusion criteria. The pooled mean age of the patients was 56.7 years, and the female rate was 56.1%. The area under the curve (AUC) of the algorithmic model to detect rotator cuff pathology from ultrasound images, MRI images, and radiographic series ranged from 0.789 to 0.950, 0.844 to 0.943, and 0.820 to 0.830, respectively. Notably, 1 of the studies reported that AI models based on ultrasound images demonstrated a diagnostic performance similar to that of radiologists. Another comparative study demonstrated that AI models using MRI images exhibited greater accuracy and specificity compared to orthopedic surgeons in the diagnosis of rotator cuff pathology, albeit not in sensitivity. CONCLUSIONS The detection of rotator cuff pathology has been significantly aided by the exceptional performance of AI models. In particular, these models are equally adept as musculoskeletal radiologists in using ultrasound to diagnose rotator cuff pathology. Furthermore, AI models exhibit statistically superior levels of accuracy and specificity when using MRI to diagnose rotator cuff pathology, albeit with no marked difference in sensitivity, in comparison to orthopaedic surgeons. LEVEL OF EVIDENCE Level III, systematic review of Level III studies.
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Affiliation(s)
- Hongwei Zhan
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Fei Teng
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Zhongcheng Liu
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Zhi Yi
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Jinwen He
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Yi Chen
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Bin Geng
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Yayi Xia
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China.
| | - Meng Wu
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
| | - Jin Jiang
- Lanzhou University Second Hospital, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou Gansu, China
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13
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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14
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Erber B, Hesse N, Goller S, Reidler P. [Pathologies of the shoulder joint : Anatomy and examination techniques]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:101-109. [PMID: 38085326 DOI: 10.1007/s00117-023-01246-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 01/27/2024]
Abstract
CLINICAL ISSUE The movements and stability of the human shoulder are a complex dynamic interaction between several joints, muscles and ligaments, which on the one hand enable extensive mobility and on the other hand must provide the necessary stability. Furthermore, the complexity of the shoulder is increased by a large number of normal variants. This article aims to explain the relevant anatomical structures and the radiological examination techniques necessary to visualize them. STANDARD RADIOLOGICAL PROCEDURES Various modalities contribute to the examination of the shoulder. These include X‑rays, computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. METHODOLOGICAL INNOVATION It is important to use the various procedures appropriately. Especially with MRI arthrography, it is necessary to pay attention to suitable sequences and possibly additional examination positions. PRACTICAL RECOMMENDATION The multimodal examination of the shoulder can contribute to the diagnosis of numerous clinical pictures. Anatomical and methodological foundations are essential for this.
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Affiliation(s)
- B Erber
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland.
| | - N Hesse
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
| | - S Goller
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
- Radiologie, Universitätsklinik Balgrist, Forchstr. 340, 8008, Zürich, Schweiz
| | - P Reidler
- Klinik und Poliklinik für Radiologie, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, München, Deutschland
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15
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Guo M, Wang W, Li M. Compressed sensing magnetic resonance imaging (CS-MRI) diagnosis of rotator cuff tears. Am J Transl Res 2024; 16:147-154. [PMID: 38322573 PMCID: PMC10839380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 11/15/2023] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The present prospective study was performed to evaluate the diagnostic efficiency of compressed sensing magnetic resonance imaging (CS-MRI) for rotator cuff tears. METHODS Between December 1, 2021 and April 1, 2022, 62 patients with suspected rotator cuff tears were admitted to Affiliated Hospital of Jinggangshan University and received CS-MRI and arthroscopy to determine the diagnosis and the disease type of tears. Their medical data were obtained and analyzed to evaluate the clinical feasibility of CS-MRI in diagnosing rotator cuff tears. RESULTS Of the 62 cases of suspected rotator cuff tears, 45 were confirmed by arthroscopy, including 31 cases of total tears and 14 partial tears. Using arthroscopic findings as the gold standard for the diagnosis of rotator cuff tears, the sensitivity of clinical signs to diagnose rotator cuff tears was 66.67%, the specificity was 70.59%, and the accuracy was 67.74%, while the sensitivity of CS-MRI in diagnosing rotator cuff tears was 84.44%, the specificity was 88.24%, and the accuracy was 81.54%. The accuracy of CS-MRI was significantly higher than that of clinical signs as determined by chi-square test within groups (P=0.019). CONCLUSION CS-MRI provides high resolution for muscles, tendons, and soft tissues, significantly contributing to the diagnosis of soft tissue injuries. Although there were no significant differences in the sensitivity and specificity of CS-MRI for the clinical diagnosis of rotator cuff tears compared to the clinical signs, CS-MRI significantly improved the diagnostic accuracy.
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Affiliation(s)
- Meiyuan Guo
- Imaging Division, Affiliated Hospital of Jinggangshan UniversityNo. 110, Jinggangshan Avenue, Jizhou District, Ji’an 343000, Jiangxi, China
| | - Wei Wang
- Imaging Division, Affiliated Hospital of Jinggangshan UniversityNo. 110, Jinggangshan Avenue, Jizhou District, Ji’an 343000, Jiangxi, China
| | - Maoying Li
- Ji’an City Qingyuan District Center for Disease Control and PreventionJi’an 343000, Jiangxi, China
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16
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Wu YM, Tang H, Xiao YF, Xiong YL, Liu WJ, Meng JH, Gao SG. Interposition Grafting Using Fascia Lata Autograft for Failed Rotator Cuff Repairs. Arthrosc Tech 2024; 13:102822. [PMID: 38312872 PMCID: PMC10837973 DOI: 10.1016/j.eats.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/27/2023] [Indexed: 02/06/2024] Open
Abstract
Massive rotator cuff tears are a huge challenge for orthopaedic surgeons, as the patients may be in need of multiple operations, even including reverse total shoulder arthroplasty. The various repair methods for the rotator cuff, such as partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and superior capsular reconstruction, have always been the focus of research. During surgical intervention for failed rotator cuff repairs, complexity of tears, poor tissue quality, retained hardware, and adhesions are the problems routinely encountered. In this Technical Note, we describe the technique of interposition grafting using fascia lata autograft to reconstruct the rotator cuff after failed primary repair.
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Affiliation(s)
- Yu-Mei Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hang Tang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Fan Xiao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yi-Lin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei-Jie Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jia-Hao Meng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shu-Guang Gao
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan, China
- Hunan Engineering Research Center of Osteoarthritis, Changsha, Hunan, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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17
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Bradley D, Harrison J, Goodall M, Dobrashian R. Are Advanced Clinical Practitioners perfectly placed to re-report neuroimages to support clinical diagnosis of dementia? INTERNATIONAL JOURNAL FOR ADVANCING PRACTICE 2023; 1:146-150. [PMID: 38229770 PMCID: PMC7615529 DOI: 10.12968/ijap.2023.1.3.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
With the ageing population, the prevalence of dementia is increasing worldwide. There is an emphasis on early, timely diagnosis and treatment options for people with a dementia yet wait times from referral to diagnosis have increased. Neuroimaging performed by radiologists is utilised to support dementia diagnosis and some patients will already have a CT scan from a pre-existing condition such as stroke. The purpose of this commentary is to consider whether ACPs who specialise in dementia, are perfectly placed to re-report on pre-existing neuroimages to support the clinical diagnosis of dementia.
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Affiliation(s)
| | - Joanna Harrison
- Synthesis Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire
| | - Mark Goodall
- Institute of Population Health, University of Liverpool
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18
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Osterholt AC, Link TW, Abrar DB, Mewes AD, Hufeland M, Schleich C, Bittersohl B. Diagnostic performance of a 3D double-echo steady-state sequence at 3 T using radial reformats for detecting and grading rotator cuff tears: a pilot diagnostic accuracy study with magnetic resonance imaging and arthroscopic correlation. Acta Radiol 2023; 64:2768-2776. [PMID: 37603569 DOI: 10.1177/02841851231190359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND In diagnosing rotator cuff tears (RCTs), magnetic resonance imaging (MRI) is the imaging modality of choice, and its accuracy is improving constantly. PURPOSE To evaluate the diagnostic performance of a high-resolution 3D double-echo steady-state (DESS) sequence with radial and paracoronal 3-T MRI regarding the grading of RCTs in correlation with conventional 2D MRI and arthroscopic findings. MATERIAL AND METHODS We retrospectively compared arthroscopic findings of RCTs with preoperative MRI, including conventional 2D sequences and radial and paracoronal DESS images in 20 patients. Two observers evaluated supraspinatus (SSP), infraspinatus (ISP), and subscapularis (SSC) tendon tears using a grading system. For statistical analysis, arthroscopy was used as the reference standard. RESULTS Inter-observer agreement for detecting and grading SSP, ISP, and SSC tendon tears on radial and paracoronal sliced 3D DESS MRI was excellent (intraclass-correlation [ICC] = 0.92-0.98; all P < 0.001). Regarding the detection of SSP lesions, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 93.8%, 50%, 88.2%, and 66.7% for both radial and paracoronal DESS imaging. A sensitivity of 100%, specificity of 61.1%, PPV of 22.2%, and NPV of 100% were noted for detecting ISP tendon tears using radially reformatted DESS images. Regarding detecting SSC tendon tears using radially reformatted DESS images, sensitivity, specificity, PPV, and NPV were 100%, 81.3%, 50%, and 100%, respectively. The results with standard 2D MRI were similar. CONCLUSION The DESS technique with radially reformatted images provided excellent sensitivity and high inter-observer agreement in detecting RCTs. It showed a moderate to high correlation between MRI and arthroscopy for diagnosing SSP and SSC tendon tears.
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Affiliation(s)
- Ann-Carolin Osterholt
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Tobias W Link
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel B Abrar
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Alexander D Mewes
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Martin Hufeland
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | | | - Bernd Bittersohl
- Department of Orthopedic and Trauma Surgery, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
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19
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Chu PC, Chang CH, Lin CP, Wu WT, Chen LR, Chang KV, Özçakar L. The impact of shoulder pathologies on job discontinuation and return to work: a pilot ultrasonographic investigation. Eur J Phys Rehabil Med 2023; 59:564-575. [PMID: 37539778 PMCID: PMC10664813 DOI: 10.23736/s1973-9087.23.07889-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/11/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Ultrasound imaging has emerged as one of the most useful tools for evaluating shoulder disorders. To date, the association between shoulder ultrasonography and a patient's work status has rarely been explored by antecedent studies. AIM This study aimed to investigate the association between sonographically diagnosed shoulder pathologies and job discontinuation and return to work. DESIGN A cross-sectional study. SETTING Outpatient clinic in the university hospital. POPULATION Fifty-nine patients who were older than 20 years of age and had worked in a full-time job within the past three years. METHODS All participants underwent clinical evaluation using the visual analog scale (for pain), Shoulder Pain and Disability Index, Pittsburgh Sleep Quality Index, and shoulder ultrasound examination. The work-related ergonomic risks, including dealing with heavy objects, repeated use and requiring forceful motion of the affected upper extremity, were assessed. The ultrasound-identified shoulder pathologies associated with job discontinuation, that is, sick leave due to painful shoulder for more than two consecutive months, were considered as the primary outcome. In the job discontinuation subgroup, we further investigated the association between return to work and the clinical/sonographic findings. RESULTS Univariate analysis revealed a positive association between job discontinuation and shoulder surgery or work types requiring forceful upper-limb movements. Multivariate analysis demonstrated that job discontinuation was positively associated with supraspinatus tendon full-thickness tears (risk ratio, 8.80; 95% CI, 1.77-10.56; P=0.018). Of the patients who received shoulder surgery, 46.6% had recurrent rotator cuff tears. Return to work was likely to be related to pain scores during overhead activities and shoulder function impairment but not to sonographic findings. CONCLUSIONS Job discontinuation is associated with shoulder surgery, work that necessitates forceful upper-extremity movements and supraspinatus tendon full-thickness tears detected by ultrasound. CLINICAL REHABILITATION IMPACT Sonographic findings should not be used as the only standard for evaluating the patient's work capability.
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Affiliation(s)
- Po-Ching Chu
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Hsun Chang
- Department of Orthopedics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lan-Rong Chen
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation and Community and Geriatric Research Center, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan -
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Türkiye
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20
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Selame L, Walsh L, Schwid M, Al Jalbout N, Gray MR, Dashti M, Shokoohi H. Point-of-Care Ultrasound Unveiling Rotator Cuff Injuries in the Emergency Department: A Case Series. Cureus 2023; 15:e47665. [PMID: 38021501 PMCID: PMC10670987 DOI: 10.7759/cureus.47665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Acute shoulder pain is a common ED presentation with a wide range of pathologies that are often initially investigated with radiography. However, diagnosing rotator cuff injuries often requires further imaging for proper diagnosis and management. Bedside shoulder ultrasound is an application that allows for the evaluation of ligaments and tendons in addition to bony structures, all while utilizing direct patient feedback of focally tender areas, expediting diagnosis and therapeutic intervention. In this case series, we discuss our evaluation of patients with suspected rotator cuff pathology and the practice of using the stepwise shoulder ultrasound protocol. Four cases are presented that illustrate the use of shoulder ultrasound in diagnosing biceps tendon injury, supraspinatus tear, chronic supraspinatus tear with hemarthrosis, and subacromial-subdeltoid bursitis. This narrative highlights the valuable role of shoulder ultrasound for the expedited diagnosis and management of patients whose initial shoulder radiographs do not indicate any bony abnormalities.
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Affiliation(s)
- Lauren Selame
- Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Lindsay Walsh
- Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Madeline Schwid
- Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Nour Al Jalbout
- Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Morgan R Gray
- Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Munaa Dashti
- Emergency Medicine, Amiri Hospital, Kuwait City, KWT
| | - Hamid Shokoohi
- Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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21
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Demino C, Koesarie K, Smith J, Fowler JR. Ultrasound Use by Upper Extremity Surgeons in 2020: A Survey of ASSH Members. Hand (N Y) 2023; 18:1222-1229. [PMID: 35373624 PMCID: PMC10798197 DOI: 10.1177/15589447221082170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND The use of musculoskeletal ultrasound (US) among hand surgeons appears to be increasing. The purpose of this study was to determine the utilization patterns and attitudes regarding US among American Society for Surgery of the Hand (ASSH) members in 2020 as well as the changes in usage patterns since a previous survey in 2015. METHODS In 2020, an updated and expanded 27-question survey was distributed to 4852 members of the ASSH. Questions assessed respondent demographics, training, and practice patterns, and access, utilization, training, and opinions pertaining to US. RESULTS A total of 418 surveys (8.6%) were analyzed. Compared to 2015, there was an increase in the percentage of respondents using US for diagnostic purposes (51%-68%), as well as having personal access to US machines (43% to 58%). US use to assist in diagnosing carpal tunnel syndrome increased from 19% to 27%. The most common reason for using US was convenience and practice efficiency, while the most common reasons for not using US was no machine access. In 2020, 33% of respondents performed US-guided injections. CONCLUSIONS Compared to 2015, the majority of responding upper extremity surgeons now have personal access to US machines. Utilization of diagnostic US appears to be increasing, and two-thirds of respondents believed that US use will continue to increase among upper extremity surgeons.
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Ferrell JL, Dodson A, Martin J. Microfragmented adipose tissue in the treatment of a full-thickness supraspinatus tear: a case report. Regen Med 2023; 18:773-780. [PMID: 37727974 DOI: 10.2217/rme-2023-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
A 70-year-old female presented with an 8-month history of right anterior shoulder pain and weakness, unresolved with conservative management. Among other shoulder pathology, the patient was diagnosed with a full-thickness supraspinatus tear and elected to proceed with the microfragmented adipose tissue procedure to treat the injured tendon and nearby relevant structures. Improvements in pain and function were documented along with progressive healing of the supraspinatus on ultrasound and MRI following the procedure. This case demonstrates the efficacy of microfragmented adipose tissue as a relatively novel approach to treating non-retracted, full-thickness rotator cuff tears.
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Affiliation(s)
- John L Ferrell
- Regenerative Orthopedics and Sports Medicine, Washington DC, 20036, USA
| | - Alanna Dodson
- Regenerative Orthopedics and Sports Medicine, Washington DC, 20036, USA
| | - Joshua Martin
- Regenerative Orthopedics and Sports Medicine, Washington DC, 20036, USA
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23
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Sood A, Kashikar SV, Mishra GV, Parihar P, Khandelwal S, Suryadevara M, Manuja N, Saboo K, Batra N, Ahuja A. The Spectrum of Shoulder Pathologies on Magnetic Resonance Imaging: A Pictorial Review. Cureus 2023; 15:e44801. [PMID: 37809114 PMCID: PMC10558894 DOI: 10.7759/cureus.44801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.
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Affiliation(s)
- Anshul Sood
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivali V Kashikar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shreya Khandelwal
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Manasa Suryadevara
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishtha Manuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Keyur Saboo
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitish Batra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhinav Ahuja
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Wu H, Zuo Z, Li Y, Song H, Hu W, Chen J, Xie C, Lin L. Anatomic characteristics of shoulder based on MRI accurately predict incomplete rotator cuff injuries in patients: relevance for predictive, preventive, and personalized healthcare strategies. EPMA J 2023; 14:553-570. [PMID: 37605646 PMCID: PMC10439871 DOI: 10.1007/s13167-023-00333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/03/2023] [Indexed: 08/23/2023]
Abstract
Background and PPPM-related working hypothesis In the diagnosis of incomplete rotator cuff injuries (IRCI), magnetic resonance imaging (MRI) and ultrasound examination often have false-positive and false-negative results, while arthroscopy is expensive, invasive, and complex. From the strategy of predictive, preventive, and personalized medicine (PPPM), shoulder anatomical characteristics based on MRI have been demonstrated to accurately predict IRCI and their clinical applicability for personalized prediction of IRCI. Aims This study aimed to develop and validate a nomogram based on anatomical features of the shoulder on MRI to identify IRCI for PPPM healthcare strategies. Methods The medical information of 257 patients undergoing preoperative MRI examination was retrospectively reviewed and served as the primary cohort. Partial-thickness rotator cuff tears (RCTs) and tendinopathy observed under arthroscopy were considered IRCI. Using logistic regression analyses and least absolute shrinkage and selection operator (LASSO), IRCI was identified among various preoperative factors containing shoulder MRI and clinical features. A nomogram was constructed and subjected to internal and external validations (80 patients). Results The following eight independent risk factors for IRCI were identified:AgeThe left injured sidesThe Goutallier classification of supraspinatus in oblique coronal positionThe Goutallier classification of supraspinatus in the axial positionAcromial thicknessAcromiohumeral distanceCoracohumeral distanceAbnormal acromioclavicular joint signalsThe nomogram accurately predicted IRCI in the development (C-index, 0.932 (95% CI, 0.891, 0.973)) and validation (C-index, 0.955 (95% CI, 0.918, 0.992)) cohorts. The calibration curve was consistent between the predicted IRCI probability and the actual IRCI ratio of the nomogram. The decision curve analysis and clinical impact curves demonstrated that the model had high clinical applicability. Conclusions Eight independent factors that accurately predicted IRCI were determined using MRI anatomical findings. These personalized factors can prevent unnecessary diagnostic interventions (e.g., arthroscopy) and can assist surgeons in implementing individualized clinical decisions in medical practice, thus addressing the goals of PPPM. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00333-5.
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Affiliation(s)
- Hangxing Wu
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Zhijie Zuo
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Yucong Li
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Haoqiang Song
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Wanyan Hu
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Jingle Chen
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Chao Xie
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
| | - Lijun Lin
- Department of Joint and Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong People’s Republic of China
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Arora S, Popkin CA, Wong TT. Trends in MR Arthrogram Utilization at a Tertiary Care Academic Center. Curr Probl Diagn Radiol 2023; 52:346-352. [PMID: 36842885 DOI: 10.1067/j.cpradiol.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
The purpose is to evaluate the trends in MR arthrogram utilization at a tertiary care academic institution and to determine if there are factors that can be implicated in the utilization trends. Number of MR arthrograms of the shoulder, hip, and elbow from 2013-2020 at our institution were identified (n = 1882). Patient demographics including age, sex, sports participation, history of prior surgery, and physician referral were obtained. Descriptive statistics were performed to determine the prevalence of MR arthrograms. Linear regression analyses were performed to determine the relationship of time with prevalence of arthrograms. Chi-square tests and posthoc analyses with Bonferroni correction were used to assess if categorical variables were different between the years. There was overall decrease in the prevalence of MR arthrograms of the shoulder, hip, and elbow despite an increase in the overall MR volume during the study period. Linear regression models significantly predicated decrease in arthrogram prevalence with each passing year (P < 0.001). The percentage of orthopedic referrals for arthrograms in the hip (P = 0.002) and shoulder (P = < 0.001) decreased significantly towards the end of the study period. None of the other variables assessed were significant. At our tertiary care academic institution, arthrogram utilization has been drastically decreasing over the past 8 years. The percentage of orthopedic referrals for shoulder and hip arthrograms significantly decreased at the end of the study period.
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Affiliation(s)
- Silvia Arora
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032
| | - Charles A Popkin
- Department of Orthopedic Surgery, The Center for Shoulder, Elbow, and Sports Medicine, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, PH-11, New York, NY 10032
| | - Tony T Wong
- Department of Radiology, Division of Musculoskeletal Radiology, New York-Presbyterian Hospital Columbia University Medical Center, 622 West 168th Street, MC-28, New York, NY 10032.
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Foti G, Booz C, Buculo GM, Oliboni E, Longo C, Avanzi P, Campacci A, Zorzi C. Dual-Energy CT Arthrography: Advanced Muscolo-Skelatal Applications in Clinical Practice. Tomography 2023; 9:1471-1484. [PMID: 37624110 PMCID: PMC10458814 DOI: 10.3390/tomography9040117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected contrast medium is subtracted from the articular cavity in order to better analyze 2D and 3D images of the bone. Moreover, virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non-calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore, the role of iodine maps in enhancing the contrast between soft tissues, optimizing the visualization of contrast material, and distinguishing contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high-spatial-resolution dual-energy CT reconstructed images.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany;
| | | | - Eugenio Oliboni
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Chiara Longo
- Department of Radiology, IRCCS Sacro Cuore Hospital, Via Don A. Sempreboni 10, 37042 Negrar, Verona, Italy; (E.O.); (C.L.)
| | - Paolo Avanzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
| | - Antonio Campacci
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
| | - Claudio Zorzi
- Department of Orthopedic Surgery, IRCCS Sacro Cuore Hospital, 37042 Negrar, Verona, Italy; (P.A.); (A.C.)
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Chowdhury A, Gibson C, Nicholls A, MacLeod I, Colaco H. Diagnostic Needle Arthroscopy of the Shoulder: A Validation Study. Orthop J Sports Med 2023; 11:23259671231155885. [PMID: 37576458 PMCID: PMC10413894 DOI: 10.1177/23259671231155885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/26/2022] [Indexed: 08/15/2023] Open
Abstract
Background Diagnostic needle arthroscopy offers an alternative imaging modality to magnetic resonance imaging (MRI) for the diagnosis of intra-articular pathology. Purpose To compare the accuracy of a needle arthroscopy device (Mi-eye2) versus MRI in identifying intra-articular anatomic abnormalities in the glenohumeral joint, with formal arthroscopy as the gold standard. Study Design Cohort study; Level of evidence, 2. Methods A total of 22 patients underwent diagnostic needle arthroscopy of the shoulder, of whom 20 had preoperative MRI scans. A standardized 12-point noninstrumented diagnostic arthroscopy was performed on each patient using the 0° needle arthroscope, followed by a 30°, 4 mm-diameter conventional arthroscope. Intraoperative images were randomized and reviewed by 2 independent blinded fellowship-trained shoulder surgeons for identification of key pathology and anatomic structures. The MRI scans were reviewed by a single musculoskeletal radiologist to identify pathology in the same key areas. Results For the identification of rotator cuff pathology, needle arthroscopy (sensitivity, 0.75; specificity, 1.00) was superior to MRI (sensitivity, 0.75; specificity, 0.75) with an interobserver reliability (κ) of 0.703. For long head of the biceps pathology, needle arthroscopy (sensitivity, 0.67; specificity, 0.95) was superior to MRI (sensitivity, 0.00; specificity, 0.83). It was less accurate for labral (sensitivity, 0.33; specificity, 0.50; κ = 0.522) and articular cartilage pathology (sensitivity, 0.00; specificity, 0.94; κ = 0.353). The number of anatomic structures that could be clearly identified was 8.35 of 12 (69.58%) for needle arthroscopy versus 10.35 of 12 (86.25%) for standard arthroscopy. Conclusion Diagnostic needle arthroscopy was found to be more accurate than MRI for the diagnosis of rotator cuff and long head of the biceps pathology but was less accurate for diagnosing labral and cartilage pathology. Although the field of view of a 0° needle arthroscope is not equivalent to a 30° conventional arthroscope, it presents an alternative with potential for use in an outpatient setting.
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Affiliation(s)
- Alex Chowdhury
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | | | - Alex Nicholls
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Iain MacLeod
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - Henry Colaco
- Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
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Altmann S, Jungmann F, Emrich T, Jezycki T, Kreitner KF. ABER Position in Direct MR Arthrography of the Shoulder: Useful Adjunct or Waste of Imaging Time? ROFO-FORTSCHR RONTG 2023; 195:586-596. [PMID: 36863366 DOI: 10.1055/a-2005-0206] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE The usefulness of direct MR arthrography of the shoulder with additional ABER position (ABER-MRA) has always been discussed. The goals of the following review are to analyze the usefulness of this technique according to the available literature and present recommendations with respect to indications and benefits in diagnostic imaging of shoulder abnormalities in the clinical routine. METHOD For this review we assessed the current literature databases of the Cochrane Library, Embase, and PubMed with regard to MRA in the ABER position up to the February 28, 2022. Search terms were "shoulder MRA, ABER", "MRI ABER", "MR ABER", "shoulder, abduction external rotation MRA", "abduction external rotation MRI" and "ABER position". The inclusion criteria were prospective and retrospective studies with surgical and/or arthroscopic correlation within 12 months. Overall, 16 studies with 724 patients fulfilled the inclusion criteria: 10 studies dealing with anterior instabilities, three studies with posterior instabilities and seven studies with suspected rotator cuff pathologies (some studies addressing multiple items). RESULTS For anterior instability the use of ABER-MRA in the ABER position led to a significant increase in sensitivity for detecting lesions of the labral ligamentous complex compared with standard 3-plane shoulder MRA (81 % versus 92 %, p = 0.001) while maintaining high specificity (96 %). ABER-MRA demonstrated high sensitivity and specificity (89 % and 100 %, respectively) for SLAP lesions and was able to detect micro-instability in overhead athletes, but case counts are still very small. With regard to rotator cuff tears, no improvement of sensitivity or specificity could be shown with use of ABER-MRA. CONCLUSION Based on the currently available literature, ABER-MRA achieves a level of evidence C in the detection of pathologies of the anteroinferior labroligamentous complex. With regard to the evaluation of SLAP lesions and the exact determination of the degree of rotator cuff injury, ABER-MRA can be of additive value, but is still a case-by-case decision. KEY POINTS · ABER-MRA is useful in the evaluation of pathologies of the anteroinferior labroligamentous complex. · ABER-MRA does not increase sensitivity or specificity with regard to rotator cuff tears. · ABER-MRA may be helpful for the detection of SLAP lesions and micro-instability in overhead athletes. CITATION FORMAT · Altmann S, Jungmann F, Emrich T et al. ABER Position in Direct MR Arthrography of the Shoulder: Useful Adjunct or Waste of Imaging Time?. Fortschr Röntgenstr 2023; 195: 586 - 595.
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Affiliation(s)
- Sebastian Altmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Florian Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Thomas Jezycki
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
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Zhou T, Han C, Weng X. Present situation and development prospects of the diagnosis and treatment of rotator cuff tears. Front Surg 2023; 10:857821. [PMID: 37440927 PMCID: PMC10333593 DOI: 10.3389/fsurg.2023.857821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/24/2023] [Indexed: 07/15/2023] Open
Abstract
Rotator cuff tears are an important cause of shoulder pain and are caused by degeneration or trauma of the shoulder tendon at the anatomical neck of the humeral head. The understanding and research of rotator cuff tears have a history of hundreds of years, and their etiology, diagnosis, and treatment have a complete system, but some detailed rules of diagnosis and treatment still have room for development. This research paper briefly introduces the diagnosis and treatment of rotator cuff tears. The current situation and its valuable research direction are described.
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Affiliation(s)
- Tianjun Zhou
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Chang Han
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
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30
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Dickinson RN, Kuhn JE. Nonoperative Treatment of Rotator Cuff Tears. Phys Med Rehabil Clin N Am 2023; 34:335-355. [PMID: 37003656 DOI: 10.1016/j.pmr.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Rotator cuff tears are common with prevalence increasing with age. Diagnosis by physical examination may require a cluster of tests. Although radiographs can be helpful, MRI, MRI arthrography, and ultrasound represent the most used imaging technique to identify rotator cuff tears. Although surgery is sometimes necessary, a large portion of patients may respond to conservative treatment including physical therapy and injections. Physical therapy should include restoring the range of motion, addressing any pectoralis minor or posterior capsule stiffness, and restoring motor control/strength to the scapula and rotator cuff. Other conservative treatments may include nonsteroidal anti-inflammatory drugs, corticosteroid injects, and platelet-rich plasma.
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Affiliation(s)
- Rebecca N Dickinson
- Vanderbilt Orthopedics Nashville, 1215 21 Street Avenue South, Suite 3200, Medical Center East, South Tower, Nashville, TN 37232, USA.
| | - John E Kuhn
- Vanderbilt Orthopedics Nashville, 1215 21 Street Avenue South, Suite 3200, Medical Center East, South Tower, Nashville, TN 37232, USA
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Chai JW, Lee JH, Kim DH, Park J, Oh SH, Shin SM. Effect of Patient's Positioning on the Grade of Tendinosis and Visible Range of Infraspinatus Tendon on Ultrasound. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:627-637. [PMID: 37325003 PMCID: PMC10265234 DOI: 10.3348/jksr.2022.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/16/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Purpose To investigate the effect of patient positioning on tendinosis grade, visible range, and infraspinatus tendon (IST) thickness, and to determine the feasibility of internal rotation (IR) position to assess IST on ultrasound (US). Materials and Methods This study included 52 shoulders of 48 subjects who were evaluated for IST in three different positions: neutral position (N), IR, and position with the ipsilateral hand on the contralateral shoulder (HC). Two radiologists retrospectively graded IST tendinosis from grade 0 to grade 3 and the visible range from grade 1 to grade 4. The thickness of the IST was measured by another radiologist with a short-axis view. A generalized estimating equation was used for statistical analysis. Results The tendinosis grades were higher in the HC position than in the IR position, with a cumulative odds ratio of 2.087 (0.004, 95% confidence interval [CI]: 1.268-3.433). The tendinosis grades in the HC position (p = 0.370) and IR position (p = 0.146) were not significantly different from those in the N position. The overall difference in IST thickness was significant (p < 0.001), but the visible range (p = 0.530) was not significantly different according to position. Conclusion Patient positioning significantly affected the grade of tendinosis and thickness but not the visible range of the IST. The IR position is a feasible position for assessing the IST on US.
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Chen X, Wang Y, Chen J, Zhang F, Xu L, Yan X, Zhu Y, Zhang Q, Tang J. Clinical value of three-dimensional ultrasonography in the morphologic evaluation of rotator cuff tear: a prospective study. Eur Radiol 2023; 33:2331-2339. [PMID: 36418625 DOI: 10.1007/s00330-022-09213-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/15/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study the clinical value of three-dimensional ultrasonography (3D-US) in the morphological evaluation of rotator cuff tears (RCTs). METHODS Based on previously published literature, RCT patterns in our study were divided into crescent, L-shaped with the remnant tendon retracted to the anterior rotator cuff (aL-shaped), L-shaped with the remnant tendon retracted to the posterior rotator cuff (pL-shaped), T-shaped (a tear pattern that is a combination of aL-shaped and pL-shaped), U-shaped, and massive type. Two radiologists prospectively assessed the tear patterns using 3D-US as well as magnetic resonance imaging (MRI) and compared these results using arthroscopy to calculate diagnostic accuracy. RESULT Fifty-two patients (52 shoulders) were enrolled. The overall diagnostic accuracy of 3D-US in evaluating RCT patterns (82.7%, 43/52; 95% CI: 72.1-93.3%) was significantly higher (p = 0.008) than that of the MRI (57.7%, 31/52; 95% CI: 45.8-73.4%). The accuracy of 3D-US was higher than that of MRI for most types of tears (crescent: 95.0% vs. 55.0%, aL-shaped: 83.3% vs. 77.8%, pL-shaped: 50.0% vs. 25.0%, T-shaped: 75.0% vs. 0.0%, and massive type: 80.0% vs. 100.0%). The accuracies of 3D-US with respect to evaluation by the two radiologists were 84.6% (44/52) and 76.9% (40/52), and there was substantial agreement evident (κ = 0.709). The time taken by the two radiologists to reconstruct the 3D-US images and evaluate the tear pattern was < 5 min. CONCLUSION The 3D-US can be used for the preoperative evaluation of RCT patterns, and thus be useful for the correct selection of the surgical repair technique for RCTs. KEY POINTS • Few studies have been found exploring the value of 3D-US for the morphological evaluation of RCTs and correlated with the arthroscopic findings. • Based on previous studies on the morphological classification, anterior L shape (aL-shaped), and posterior L shape (pL-shaped) were used for the first time to describe the torn patterns of RCT.
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Affiliation(s)
- Xianghui Chen
- Chinese People's Liberation Army (PLA) Medical School, Fuxing Road 28, Beijing, 100853, China.,Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yuexiang Wang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Jian Chen
- Nankai University, Weijin Road 94, Nankai District, Tianjin, 300071, China
| | - Fei Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Lin Xu
- Department of Radiology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Xu Yan
- Department of Radiology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yaqiong Zhu
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Qiang Zhang
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Jie Tang
- Department of Ultrasound, The First Medical Center of PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Diagnostic sensitivity of ultrasound of the supraspinatus tendon when compared to magnetic resonance imaging prior to arthroscopy: A retrospective study. SONOGRAPHY 2023. [DOI: 10.1002/sono.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
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Current Understanding and New Advances in the Surgical Management of Reparable Rotator Cuff Tears: A Scoping Review. J Clin Med 2023; 12:jcm12051713. [PMID: 36902499 PMCID: PMC10003213 DOI: 10.3390/jcm12051713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/05/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Rotator cuff (RC) tears are among the most common musculoskeletal disorders and can be associated with pain, weakness, and shoulder dysfunction. In recent years, there have been significant advances with regard to the understanding of rotator cuff disease and its management. With technological improvements and advanced diagnostic modalities, there has been much progress as to improved understanding of the pathology. Similarly, with advanced implant designs and instrumentation, operative techniques have evolved. Furthermore, refinements in postoperative rehabilitation protocols have improved patient outcomes. In this scoping review, we aim to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight recent advances in its management.
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Yoon TH, Kim SJ, Choi YR, Kang KT, Chun YM. Age, Tear Size, Extent of Retraction, and Fatty Infiltration Associated With a High Chance of a Similar Rotator Cuff Tear in the Contralateral Shoulder Regardless of Symptoms in Patients Undergoing Cuff Repair in the Index Shoulder. Arthroscopy 2023:S0749-8063(23)00174-3. [PMID: 36804457 DOI: 10.1016/j.arthro.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/26/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To investigate the prevalence of a contralateral rotator cuff tear (RCT) in patients with a symptomatic RCT requiring repair and to determine whether findings from magnetic resonance imaging (MRI) of the affected shoulder can predict the presence of a contralateral tear. METHODS Patients with atraumatic RCTs who had undergone arthroscopic repair between March 2019 and February 2021 were reviewed in this study. MRI of both shoulder joints was performed to evaluate the bilaterality of RCT. Demographic factors and MRI findings of index shoulders were assessed using logistic regression analysis to reveal any correlations with the presence of RCT in the contralateral shoulder. RESULTS A total of 428 patients were enrolled in this study. When the affected shoulders had a posterosuperior rotator cuff (PSRC) or subscapularis tear including either an isolated or combined tear, 63.6% and 67.8% had the same tears on the contralateral side, respectively. A contralateral-side tear was found in 74.6% (185/248) of symptomatic cases and 44.8% (65/145) of asymptomatic cases, which represents a significant difference (P < .001). Logistic regression analysis revealed that age ≥67.5 years, tear size ≥17 mm, Goutallier grade ≥1.5, and Patte grade ≥1.5 were found to be indicative of potential contralateral PSRC tears. By contrast, the presence of a subscapularis tear in the affected shoulder was the only significant risk factor in predicting a potential subscapularis tear in the contralateral shoulder. CONCLUSIONS Among patients with a symptomatic RCT requiring arthroscopic repair, 63.6% with a PSRC tear and 67.8% with a subscapularis tear in the affected shoulder were found to have a similar tear in the contralateral shoulder regardless of symptoms. Age, tear size, extent of retraction, fatty infiltration of PSRC tears, and the presence of subscapularis tears were identified as factors predictive of tears on the contralateral side. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Tae Kang
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Manske RC, Page P, Voight M, Wolfe C. EDITORIAL: MSK Ultrasound and Introduction of IJSPT Ultrasound Bites Feature. Int J Sports Phys Ther 2023; 18:68139. [PMID: 36793580 PMCID: PMC9897035 DOI: 10.26603/001c.68139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | - Phil Page
- Doctor of Physical Therapy Program Franciscan University
| | | | - Chris Wolfe
- School of Physical Therapy Belmont University
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Uno T, Mura N, Yuki I, Takagi M. Shoulder activity of the contralateral shoulder as a prognostic factor in patients with arthroscopic rotator cuff repair. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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de Barros RSM, Sant’ Anna CDC, Alcantara DDFÁ, Pantoja KBCC, Fernandes MR, Bentes LGDB, Pimentel ALJC, Lemos RS, de Almeida NRC, Fernandes MRN, da Cruz TS, Candido ADA, Burbano RMR. Association between the rs820218 Variant within the SAP30BP Gene and Rotator Cuff Rupture in an Amazonian Population. Genes (Basel) 2023; 14:genes14020367. [PMID: 36833294 PMCID: PMC9957240 DOI: 10.3390/genes14020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/15/2022] [Accepted: 12/27/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Rotator cuff disease is one of the leading causes of musculoskeletal pain and disability, and its etiology is most likely multifactorial but remains incompletely understood. Therefore, the objective of this research was to investigate the relationship of the single-nucleotide rs820218 polymorphism of the SAP30-binding protein (SAP30BP) gene with rotator cuff tears in the Amazonian population. METHODS The case group consisted of patients who were operated on due to rotator cuff tears in a hospital in the Amazon region between 2010 and 2021, and the control group was composed of individuals who were selected after negative physical examinations for rotator cuff tears. Genomic DNA was obtained from saliva samples. For the genotyping and allelic discrimination of the selected single nucleotide polymorphism (rs820218) in the SAP30BP gene, real-time PCR was performed. RESULTS The frequency of the A allele in the control group was four times as high as that in the case group (AA homozygotes); an association of the genetic variant rs820218 of the SAP30BP gene with rotator cuff tears was not established (p = 0.28 and 0.20), as the A allelic frequency is ordinarily low in the general population. CONCLUSIONS The presence of the A allele indicates protection against rotator cuff tears.
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Affiliation(s)
- Rui Sergio Monteiro de Barros
- Hospital Ophir Loyola, Belém 66063-240, Brazil
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém 66087-662, Brazil
- Rede Mater Dei—Hospital Porto Dias, Belém 66093-020, Brazil
| | | | | | | | | | | | | | - Rafael Silva Lemos
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém 66087-662, Brazil
| | | | | | - Thiago Sequeira da Cruz
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém 66087-662, Brazil
| | | | - Rommel Mario Rodriguez Burbano
- Hospital Ophir Loyola, Belém 66063-240, Brazil
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil
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Ting DS, Yang JL, Lin KH, Wang TG, Lin JJ. Alteration in coracohumeral ligament and distance in people with symptoms of subcoracoid impingement. BMC Musculoskelet Disord 2023; 24:58. [PMID: 36683027 PMCID: PMC9869551 DOI: 10.1186/s12891-023-06152-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/09/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Differentiation between subacromial impingement versus subcoracoid impingement are important for the treatment target. We evaluated the correlations between coracohumeral ligament (CHL) thickness and distance (CHD) and characterized the CHL and subscapularis (SSC) in subcoracoid impingement subjects. METHODS An observational, cross-sectional study was carried out. Twenty subcoracoid impingement subjects and age/gender matched controls were assessed in 4 different shoulder positions by ultrasonography. RESULTS Moderate correlations between CHL thickness with CHD (r = 0.455 in neutral rotation, p = 0.044; r = 0.483 in interior rotation, p = 0.031) were found in subacromial subjects. Subcoracoid impingement subjects had greater CHL thickness (difference = 0.3 mm, effect size = 0.85, p = 0.006), SSC tendon thickness (difference = 0.7 mm, effect size = 0.92, p = 0.01) and SSC/CHD occupation ratio (difference = 8%, effect size = 0.95, p = 0.005) compared with the control. CONCLUSIONS Coracohumeral distance is related to ligament thickness, especially in subacromial impingement subjects. Increased coracohumeral ligament and subscapularis thickness as well as decreased subscapularis/coracohumeral distance occupation ratio are characterized in subcoracoid impingement subjects. These quantitative measurements can be useful in identifying patients at risk of subcoracoid impingement from subacromial impingement.
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Affiliation(s)
- Deng Siang Ting
- grid.19188.390000 0004 0546 0241School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Jing-lan Yang
- grid.412094.a0000 0004 0572 7815Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kwan-Hwa Lin
- grid.19188.390000 0004 0546 0241School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Tyng-Guey Wang
- grid.412094.a0000 0004 0572 7815Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jiu-Jenq Lin
- grid.19188.390000 0004 0546 0241School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan ,grid.412094.a0000 0004 0572 7815Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
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Wang YC, Chen HC, Wong CC, Chang WP, Lin CH, Liaw CK, Chen CH, Weng PW. Comparison of Locking-Loop Suture Bridge Repair and Single-Row Suture Anchor Repair in Small to Medium Rotator Cuff Tears: A Prospective Cohort Study With Clinical and Ultrasound Evaluations. Orthop J Sports Med 2023; 11:23259671221142242. [PMID: 36636031 PMCID: PMC9830097 DOI: 10.1177/23259671221142242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/13/2022] [Indexed: 01/07/2023] Open
Abstract
Background Single-row (SR) and double-row repair techniques have been described to treat rotator cuff tears. We present a novel surgical strategy of arthroscopic-assisted mini-open repair in which a locking-loop suture bridge (LLSB) is used. Purpose To compare the functional outcomes and repair integrity of LLSB technique to the SR technique for arthroscopic-assisted mini-open repair of small to medium rotator cuff tears. Study Design Cohort study; Level of evidence, 3. Methods Included were 39 patients who underwent LLSB repair (LLSB group) and 44 patients who underwent SR suture anchor repair (SR group) from 2015 to 2018. We evaluated all patients preoperatively and at 3, 6, 12, and 24 months postoperatively using the visual analog scale (VAS) for pain, Oxford Shoulder Score (OSS), and American Shoulder and Elbow Surgeons (ASES) score. Also, shoulder sonography was performed at 12 months postoperatively to evaluate repair integrity using the Sugaya classification system. The independent-sample t test was used to analyze functional outcomes (VAS, OSS, and ASES scores), and the Fisher exact test was used to analyze postoperative sonography results. Results Patients in both the LLSB and SR groups saw a significant improvement on all 3 outcome measures from preoperatively to 24 months postoperatively (P < .001 for all). However, when comparing scores between groups, only the scores at 3 months postoperatively differed significantly (VAS: P = .002; OSS: P < .001; ASES: P = .005). Shoulder sonography at 12 months postoperatively revealed no significant difference in repair integrity between the LLSB and SR groups (retear rate: 10.26% and 6.82%, respectively; P = .892). Conclusion Better outcome scores were seen at 3-month follow-up in the LLSB group, with no difference in retear rates compared with the SR group at 12 months postoperatively. The LLSB technique was found to be a reliable technique for rotator cuff repair of small- to medium-sized tears.
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Affiliation(s)
- Yu-Chun Wang
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City
| | - Hung-Chou Chen
- Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Department of Physical Medicine and Rehabilitation, Shuang Ho
Hospital, Taipei Medical University, New Taipei City
| | - Chin-Chean Wong
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei.,Research Center for Biomedical Devices and Prototyping Production,
Taipei Medical University, Taipei.,College of Medicine, Taipei Medical University, Taipei.,Non-Invasive Cancer Therapy Research Institute of Taiwan,
Taipei
| | - Wen-Pei Chang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,College of Nursing, Taipei Medical University, Taipei
| | - Chun-Hao Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City
| | - Chen-Kun Liaw
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei
| | - Chih-Hwa Chen
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei
| | - Pei-Wei Weng
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical
University, New Taipei City.,Department of Orthopedics, College of Medicine, Taipei Medical
University, Taipei.,Graduate Institute of Biomedical Materials and Tissue Engineering,
College of Biomedical Engineering, Taipei Medical University, Taipei.,Pei-Wei Weng, MD, PhD, Taipei Medical University, Shuang Ho
Hospital, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561
()
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Zhang L, Zhu Y, Xu T, Fu W. Bone marrow stimulation in arthroscopic rotator cuff repair is a cost-effective and straightforward technique to reduce retear rates: A systematic review and meta-analysis. Front Surg 2023; 10:1047483. [PMID: 36896263 PMCID: PMC9989271 DOI: 10.3389/fsurg.2023.1047483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/23/2023] [Indexed: 02/23/2023] Open
Abstract
Background Bone marrow stimulation (BMS) has been considered a well-established method for treating knee and ankle osteochondral lesions. Some studies have also shown that BMS can promote healing of the repaired tendon and enhance biomechanical properties during rotator cuff repair. Our purpose was to compare the clinical outcomes of arthroscopic repair rotator cuff (ARCR) with and without BMS. Methods A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Embase, Web of Science, Google scholar, ScienceDirect, and the Cochrane Library were searched from inception to March 20, 2022. Data on retear rates, shoulder functional outcomes, visual analog score and range of motion were pooled and analyzed. Dichotomous variables were presented as odds ratios (OR), and continuous variables were presented as mean differences (MD). Meta-analyses were conducted with Review Manager 5.3. Results Eight studies involving 674 patients were included, with mean follow-up period ranging from 12 to 36.8 months. Compared to ARCR alone, the intraoperative combination of the BMS resulted in lower retear rates (P < 0.0001), but showed similar results in Constant score (P = 0.10), University of California at Los Angeles (UCLA) score (P = 0.57), American Shoulder and Elbow Surgeons (ASES) score (P = 0.23), Disabilities of the Arm, Shoulder and Hand (DASH) score (P = 0.31), VAS (visual analog score) score (P = 0.34), and range of motion (ROM) (forward flexion, P = 0.42; external rotation, P = 0.21). After sensitivity analyses and subgroup analyses, no significant changes in statistical results were observed. Conclusion Compared to ARCR alone, the combination of intraoperative BMS can significantly reduce the retear rates, but showed similar short-term results in functional outcomes, ROM and pain. Better clinical outcomes are anticipated in the BMS group by improving structural integrity during long-term follow-up. Currently, BMS may be a viable option in ARCR based on its straightforward and cost-effective advantages. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022323379.
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Affiliation(s)
- Lei Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yanlin Zhu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tianhao Xu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Shrestha-Taylor S, Clarke JL, Poulos A, Ginn K. Ultrasound Features for the Diagnosis of Adhesive Capsulitis/Frozen Shoulder: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:2379-2397. [PMID: 36058800 DOI: 10.1016/j.ultrasmedbio.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
While ultrasound has become a preferred tool for musculoskeletal imaging, differing ultrasound findings that have been reported in patients with adhesive capsulitis can create confusion and misconceptions. This systematic review was aimed at summarizing all the ultrasound features currently described in the literature and providing a critical analysis of the sources to allow the readers to make a well-informed decision on the reliability of these features in the diagnosis of this condition. Databases were searched for original studies up to August 2021. Twenty-three studies were included. The QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool was used to assess the quality of each selected article. Fourteen ultrasound features were identified. A quality analysis of all ultrasound features was performed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) framework. All studies exhibited considerable heterogeneity in investigated ultrasound features and methodologies employed; therefore, meta-analysis was not considered to be appropriate. Hence, narrative synthesis was performed. The overall quality of each ultrasound outcome was found to be of "low" to "very low" level, and the generalisability of the results was also thought to be limited. Cautious interpretation and clinical correlation are recommended while applying these ultrasound features in clinical practice.
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Affiliation(s)
| | - Jillian L Clarke
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Ann Poulos
- Discipline of Medical Imaging Science, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Karen Ginn
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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43
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Eckers F, Müller AM, Loske S. Aktuelle Aspekte der Behandlung der Rotatorenmanschette. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00574-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ZusammenfassungRotatorenmanschettenrupturen gehören zu den häufigsten muskuloskeletalen Erkrankungen und können mit ausgeprägten Schmerzen und Funktionseinschränkungen einhergehen. Für ihre Entstehung ist eine Vielzahl von Faktoren relevant, u. a. die individuelle Anatomie des Akromions. Mit Hilfe der heutigen technischen Möglichkeiten wurde nun festgestellt, dass zusätzlich zu seiner lateralen Ausdehnung auch die sagittale Ausdehnung des Akromions eine Rolle zu spielen scheint. Die bildgebende Darstellung der Rotatorenmanschette (RM) hat von den technischen Fortschritten der letzten Jahrzehnte ebenfalls profitiert. Magnetresonanztomographie (MRT) und MR-Arthrographie werden heute flächendeckend eingesetzt. Letztere bietet die höchste Sensitivität für die Entdeckung selbst kleiner Partialläsionen. Neue Sequenzen und Nachbearbeitungsmöglichkeiten können als hilfreiche tools für die operative Planung eingesetzt werden. Grundsätzlich richtet sich die Behandlung der RM neben der Symptomatik nach der Rupturgenese und -morphologie sowie der erwarteten Gewebequalität des Muskel-Sehnen-Kontinuums. Auch das Gesamtprofil, die Erwartungshaltung und die Rehabilitationsmöglichkeiten des Patienten sind wichtig. Die heutigen operativen Techniken werden durch spannende Entwicklungen der Industrie mitbestimmt, die in den letzten Jahren immer bessere Fadenankersysteme, aber auch Augmentationsmaterialien auf den Markt gebracht hat. Letztere zielen nicht nur auf die mechanische Verstärkung der Sehnenrekonstruktion, sondern auch auf die Optimierung der biologischen Eigenschaften des Konstrukts ab. Hinsichtlich Fixation konnte die biomechanische Forschung zeigen, dass zweireihige oder Suture-Bridge-Fixationen einreihigen oder transossären Fixationen überlegen sind. Diese Überlegenheit im Labor spiegelt sich noch nicht klar in den klinischen Ergebnissen wider, dennoch sind die meisten Chirurgen heute auf diese Technik übergegangen. Was die postoperative Nachbehandlung angeht, stellen jüngste randomisiert-kontrollierte Untersuchungen das Konzept der postoperativen Immobilisation in Abduktion in Frage. Hier scheint das letzte Wort noch nicht gesprochen zu sein.
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Yao J, Chepelev L, Nisha Y, Sathiadoss P, Rybicki FJ, Sheikh AM. Evaluation of a deep learning method for the automated detection of supraspinatus tears on MRI. Skeletal Radiol 2022; 51:1765-1775. [PMID: 35190850 DOI: 10.1007/s00256-022-04008-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if deep learning is a feasible approach for automated detection of supraspinatus tears on MRI. MATERIALS AND METHODS A total of 200 shoulder MRI studies performed between 2015 and 2019 were retrospectively obtained from our institutional database using a balanced random sampling of studies containing a full-thickness tear, partial-thickness tear, or intact supraspinatus tendon. A 3-stage pipeline was developed comprised of a slice selection network based on a pre-trained residual neural network (ResNet); a segmentation network based on an encoder-decoder network (U-Net); and a custom multi-input convolutional neural network (CNN) classifier. Binary reference labels were created following review of radiologist reports and images by a radiology fellow and consensus validation by two musculoskeletal radiologists. Twenty percent of the data was reserved as a holdout test set with the remaining 80% used for training and optimization under a fivefold cross-validation strategy. Classification and segmentation accuracy were evaluated using area under the receiver operating characteristic curve (AUROC) and Dice similarity coefficient, respectively. Baseline characteristics in correctly versus incorrectly classified cases were compared using independent sample t-test and chi-squared. RESULTS Test sensitivity and specificity of the classifier at the optimal Youden's index were 85.0% (95% CI: 62.1-96.8%) and 85.0% (95% CI: 62.1-96.8%), respectively. AUROC was 0.943 (95% CI: 0.820-0.991). Dice segmentation accuracy was 0.814 (95% CI: 0.805-0.826). There was no significant difference in AUROC between 1.5 T and 3.0 T studies. Sub-analysis showed superior sensitivity on full-thickness (100%) versus partial-thickness (72.5%) subgroups. DATA CONCLUSION Deep learning is a feasible approach to detect supraspinatus tears on MRI.
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Affiliation(s)
- Jason Yao
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada.
| | - Leonid Chepelev
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Yashmin Nisha
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Paul Sathiadoss
- Department of Radiology, University of Ottawa Faculty of Medicine, 501 Smyth Road, Box 232, Ottawa, ON, K1H 8L6, Canada
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, 234 Goodman Street, Box 670761, Cincinnati, OH, 45267-0761, USA
| | - Adnan M Sheikh
- Department of Radiology, The University of British Columbia Faculty of Medicine, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Jeong ET, Lee DR, Lee J, Lee J, Lho T, Chung SW. Does Complete Footprint Coverage Affect Outcomes After Conventional Arthroscopic Repair of Large-Sized Rotator Cuff Tears? Orthop J Sports Med 2022; 10:23259671221120598. [PMID: 36157086 PMCID: PMC9502255 DOI: 10.1177/23259671221120598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/15/2022] Open
Abstract
Background: In large-sized rotator cuff tears, tendon repair with incomplete footprint coverage is performed frequently as a way of tension-free or low-tension repair. Purpose: To compare clinical outcomes after arthroscopic repair of large-sized rotator cuff tears between patients with complete versus incomplete footprint coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Among 297 patients who underwent arthroscopic surgery for a large-sized rotator cuff tear, we selected 58 patients (<50% coverage; mean age, 63.34 ± 6.8 years; 34 men and 24 women) with incomplete footprint coverage. Using propensity score matching, another 58 patients with complete footprint coverage (mean age, 63.4 ± 8.03 years; 34 men and 24 women) were selected after 1:1 matching for age, sex, and tear size—the main demographic and prognostic factors of outcomes after rotator cuff repair. Clinical outcomes were compared on magnetic resonance imaging or ultrasonography at minimum of 6 months postoperatively, and functional outcomes were compared using range of motion and pain visual analog scale; American Shoulder and Elbow Surgeons; Constant; University of California, Los Angeles; and Simple Shoulder Test scores at a minimum of 2 years postoperatively. Results: A total of 18 patients in the incomplete footprint coverage group (31.0%) and 20 patients in the complete footprint coverage group (34.5%) showed healing failure, with no significant difference between groups (P = .843). In addition, there were no differences in functional outcomes between groups (P > .05 for all). Conclusion: Whether the rotator cuff footprint was completely covered did not affect clinical outcomes in conventional arthroscopic repair of large-sized rotator cuff tears.
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Affiliation(s)
- Eun Taek Jeong
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jihwan Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jongwon Lee
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Taewoo Lho
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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Endell D, Child C, Freislederer F, Moroder P, Scheibel M. [Anatomy and diagnostics of subscapularis tendon lesions]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:647-658. [PMID: 35819495 DOI: 10.1007/s00113-022-01207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
Among lesions of the rotator cuff, subscapularis tendon tears are one of the less common injuries and mostly occur in combination with additional lesions of the posterosuperior rotator cuff and the long biceps tendon. If a subscapularis tendon rupture is suspected in the initial clinical testing, the primary diagnostics should include modern cross-sectional magnetic resonance imaging to assess the tendon lesion and to detect concomitant pathologies. Nevertheless, subscapularis tendon lesions are often initially overlooked and first correctly diagnosed during shoulder arthroscopy.
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Affiliation(s)
- David Endell
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Christopher Child
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Florian Freislederer
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Philipp Moroder
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Cromheecke M, Garret J, Deranlot J, Bonnevialle N, Gaudin S, Lädermann A, Nourissat G. Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft. Knee Surg Sports Traumatol Arthrosc 2022; 30:2528-2534. [PMID: 35199186 DOI: 10.1007/s00167-022-06916-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In the absence of arthropathy, symptomatic massive irreparable rotator cuff tears contribute to a therapeutic challenge for orthopedic surgeons. The concept of superior capsular reconstruction (SCR) was introduced as an option for these challenging cases. The purposes of this study were to evaluate the clinical outcome scores when using a decellularized porcine xenograft and to evaluate the graft healing and incorporation. METHODS A multicentric retrospective study of consecutive SCR's performed between 2016 and 2019 by four surgeons in four centers. Preoperative and postoperative Constant score, Subjective shoulder value (SSV) and Visual analog scale for pain (VAS) were recorded. Graft healing was evaluated by ultrasound or magnetic resonance imaging (MRI). RESULTS A total of 28 shoulders were retrospectively analyzed with an average follow-up of 24 ± 9 months. One infection and four revisions (14%) to reversed shoulder arthroplasty (RSA) were reported at the final follow-up. The absolute Constant score showed a moderate, but significant improvement from 40 ± 12 to 57 ± 20 (P = 0.001). A significant improvement in pain scores was observed (P < 0.001). For patients undergoing SCR as a primary surgery, an average postoperative Constant score of 62 ± 16 was observed. This was in contrast to 43 ± 22 for patients who underwent SCR after failed rotator cuff repair. Although a strong trend in absolute differences was observed in regard to the Constant score, they did not reach statistical significance. For all other recorded outcome scores, a significant difference was reported between these groups. Graft healing was observed in (7/22) 30% of the patients. In the case of graft incorporation, an absolute constant score of 70 ± 9 was observed compared to 48 ± 21 in the graft failure group (P = 0.003). All cases with graft healing were considered to have a successful clinical outcome. This compared to only (7/15) 47% in the case of graft failure. CONCLUSIONS In these series, SCR with a dermal xenograft successfully alleviated pain, but provided only a moderate improvement in functional outcome. In the case of graft healing, satisfactory clinical outcomes and patient satisfaction were observed. The present study indicates the benefit of performing SCR as a primary surgery, yet warns against using SCR as a salvage option for failed rotator cuff repair. In this group, the use of dermal xenografts is limited by the low healing rates and high complication rate. LEVEL OF EVIDENCE IV. Retrospective case series, treatment study.
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Affiliation(s)
- Michiel Cromheecke
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France. .,AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Jérôme Garret
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France
| | | | - Nicolas Bonnevialle
- Hôpital Pierre Paul Riquet, Allée Jean Dausset, 31059, Toulouse Cedex 09, France.,Institut de Recherche Riquet (I2R), Place du Docteur Baylac, 31059, Toulouse, France
| | - Samuel Gaudin
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Geoffroy Nourissat
- Clinique des Maussins - Ramsay Santé, 69 rue de Romainville, 75019, Paris, France
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Onada Y, Sasanuma H, Umemoto T, Kajino T, Shimizu T. Isolated bursal-side infraspinatus tear diagnosed by computed tomography bursography: a case series. J Med Case Rep 2022; 16:240. [PMID: 35710518 PMCID: PMC9205116 DOI: 10.1186/s13256-022-03472-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Partial-thickness rotator cuff tears are commonly found in the articular-side tendon of the supraspinatus; however, isolated lesions, except those occurring in the supraspinatus tendons, are rare. We report three cases of isolated bursal-side infraspinatus tears that were difficult to detect by magnetic resonance imaging but could be visualized by computed tomography bursography. Case presentation Three Asian patients (59–71 years old) with shoulder pain ranging from 1 month to 3 years in duration were each diagnosed with shoulder impingement syndrome. Magnetic resonance imaging studies failed to show a tear of the rotator cuff tendon complex. However, computed tomography bursography showed a longitudinal infraspinatus partial-thickness tear on the bursal side in each case. Arthroscopic decompression of the subacromial space and debridement of the infraspinatus tendon tear successfully alleviated the shoulder pain in two of the three patients; the third patient did not undergo surgery and remained symptomatic at follow-up. Conclusions In patients with chronic shoulder pain but normal magnetic resonance imaging findings, computed tomography bursography should be considered, as bursal-side infraspinatus tears may be found in these patients. Furthermore, our findings provide a basis for larger studies to further establish the accuracy of computed tomography bursography for these lesions.
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Affiliation(s)
- Yoshihiro Onada
- Department of Orthopaedic Surgery, Tonan Hospital, 3-8 Kita-4-jo Nishi-7-chome, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan.
| | - Hideyuki Sasanuma
- Department of Sports Health Medicine, Tochigi Medical Center Shimotsuga, Tochigi, Japan
| | - Takahisa Umemoto
- Department of Orthopaedic Surgery, Tonan Hospital, 3-8 Kita-4-jo Nishi-7-chome, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Tomomichi Kajino
- Department of Orthopaedic Surgery, Tonan Hospital, 3-8 Kita-4-jo Nishi-7-chome, Chuo-ku, Sapporo, Hokkaido, 060-0004, Japan
| | - Tadashi Shimizu
- Department of Radiology, Tonan Hospital, Sapporo, Hokkaido, Japan
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Chaudhary A, Setia A, Singh D, Bhattacharya S. The potential of microbubbles as a cancer eradication theranostic agent. Pharm Nanotechnol 2022; 10:PNT-EPUB-124508. [PMID: 35708092 DOI: 10.2174/2211738510666220615154841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/16/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
Abstract
Microbubbles are a new kind of delivery system that may be used to treat a variety of illnesses, including cancer. Microbubble is a non-invasive technology that uses microscopic gas-filled colloidal particle bubbles with a size range of less than 100 micrometres. This unique carrier has been used in a variety of applications in the last decade, ranging from basic targeting to ultrasound-mediated drug delivery. The oxygen in the microbubble lasts longer in the water. The drug release mechanism is highly regulated, since it releases the medication only in the appropriate areas, increasing the local impact while reducing drug toxicity. This carrier is exceptional in cancer medication delivery because of its sustained stability, encapsulation efficiency, and drug targeting. In this paper, we provide a comprehensive analysis of microbubble technology, including its manufacturing techniques and use in cancer medication delivery.
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Affiliation(s)
- Atul Chaudhary
- Department of Pharmaceutics ISF College of Pharmacy, GT Road (NH-95), GhalKalan,Moga, Punjab 142001, Inida
| | - Aseem Setia
- Department of Pharmacy, Shri Rawatpura Sarkar University, Raipur (C.G.). Inida
| | - Dilpreet Singh
- Department of Pharmaceutics ISF College of Pharmacy, GT Road (NH-95), GhalKalan,Moga, Punjab 142001, Inida
| | - Sankha Bhattacharya
- School of Pharmacy & Technology Management Shirpur, SVKM’S NMIMS Deemed-to-be University, Shirpur, Maharashtra 425405, India
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Hong CK, Hsu KL, Kuan FC, Chang HM, Chen Y, Chiang CH, Su WR. Owen, Sugaya, and Hayashida Classifications Give Poor Intra- and Inter-Rater Agreement on a Magnetic Resonance Imaging Evaluation of Subscapularis Tendon Retears. Arthroscopy 2022; 38:1796-1801. [PMID: 34920005 DOI: 10.1016/j.arthro.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
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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Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery and Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery and Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery and Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Ming Chang
- Department of Orthopaedics, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan, Taiwan
| | - Chen-Hao Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Ren Su
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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