Predicting the surgical reparability of large-to-massive rotator cuff tears by B-mode ultrasound: a cross-sectional study
Po-Cheng Chen1,2 , Kuan-Ting Wu3 , Yi-Cun Chen1, Yu-Chi Huang1 , Ching-Di Chang4, Wei-Che Lin4 , Wen-Yi Chou3,5
1Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Kaohsiung, Taiwan
2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Tainan, Taiwan
3Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Kaohsiung, Taiwan
4Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Kaohsiung, Taiwan
5Medical Mechatronic Engineering Program, Cheng Shiu University, Kaohsiung, Taiwan, Kaohsiung, Taiwan
Corresponding Author: Wen-Yi Chou ,Tel: 886-7-731-7123, Fax: 886-7-735-4309, Email: murraychou@yahoo.com.tw
Received: December 2, 2020;  Accepted: June 6, 2021.  Published online: June 6, 2021.
ABSTRACT
Purpose:
To compare the predictability for surgical reparability of B-mode ultrasound and magnetic resonance imaging (MRI) in patients with large-to-massive rotator cuff tears (RCTs).
Methods:
This was a cross-sectional study. Participants with large-to-massive RCTs who underwent arthroscopic repair were included. B-mode ultrasound and MRI were conducted prior to arthroscopic repair. B-mode ultrasound was used to evaluated the echogenicity of rotator cuff muscle. The intra-rater and inter-rater reliabilities were examined by two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, two experienced orthopedic surgeons performed surgeries and decided whether the torn stump could be completely repaired intraoperatively.
Results:
Fifty participants were included, and 32 complete repairs and 18 partial repairs were performed. The intra-rater reliability and inter-rater reliability of B-mode ultrasound for assessment of the muscle echogenicity of the supraspinatus and infraspinatus muscles were good. The effect sizes of the correlation coefficients between B-mode ultrasound findings and MRI findings were medium to large (r = 0.4 ~ 0.8). Goutallier classification of the infraspinatus muscles had the best discriminative power in relation to surgical reparability among the MRI predictors (AUC = 0.89, 95% CI 0.81 to 0.98), while the Heckmatt scale for infraspinatus muscles was the most accurate in predicting surgical reparability (AUC = 0.85, 95% CI 0.74 to 0.96). No significant differences in the AUCs among the MRI and ultrasound predictors were found.
Conclusion:
B-mode ultrasound was a reliable examination tool and had a similar predictive ability of surgical reparability to that of MRI
Keywords: Large-to-massive rotator cuff tears; Reparability; B-mode ultrasound
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