Agreement between intraoperative and magnetic resonance imaging assessments of rotator cuff pathology and 2 magnetic resonance imaging-based assessments of supraspinatus muscle atrophy

Jinjin Ma, PhD; Sambit Sahoo, MBBS, PhD; Peter B. Imrey, PhD; Yuxuan Jin, MS; Andrew R. Baker, MS; Vahid Entezari, MD, MMSc; Jason C. Ho, MD; Mark S. Schickendantz, MD; Lutul D. Farrow, MD; Alfred Serna, MD; Joseph P. Iannotti, MD, PhD; Eric T. Ricchetti, MD; Joshua M. Polster, MD; Carl S. Winalski, MD; Kathleen A. Derwin, PhD

JSES International (Nov 2022)

Agreement between intraoperative and magnetic resonance imaging assessments of rotator cuff pathology and 2 magnetic resonance imaging-based assessments of supraspinatus muscle atrophy

Jinjin Ma, PhD,
Sambit Sahoo, MBBS, PhD,
Peter B. Imrey, PhD,
Yuxuan Jin, MS,
Andrew R. Baker, MS,
Vahid Entezari, MD, MMSc,
Jason C. Ho, MD,
Mark S. Schickendantz, MD,
Lutul D. Farrow, MD,
Alfred Serna, MD,
Joseph P. Iannotti, MD, PhD,
Eric T. Ricchetti, MD,
Joshua M. Polster, MD,
Carl S. Winalski, MD,
Kathleen A. Derwin, PhD

Affiliations

Jinjin Ma, PhD: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Sambit Sahoo, MBBS, PhD: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Peter B. Imrey, PhD: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA; Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
Yuxuan Jin, MS: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
Andrew R. Baker, MS: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
Vahid Entezari, MD, MMSc: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Jason C. Ho, MD: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Mark S. Schickendantz, MD: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Lutul D. Farrow, MD: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Alfred Serna, MD: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Joseph P. Iannotti, MD, PhD: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Eric T. Ricchetti, MD: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
Joshua M. Polster, MD: Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
Carl S. Winalski, MD: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
Kathleen A. Derwin, PhD: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA; Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA; Corresponding author: Kathleen A. Derwin, PhD, Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, ND-20, Cleveland, OH 44195, USA.

Journal volume & issue: Vol. 6, no. 6
pp. 948 – 956

Abstract

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Background: Magnetic resonance imaging (MRI)-based rotator cuff assessment is often qualitative and subjective; few studies have tried to validate such preoperative assessments. This study investigates relationships of preoperative MRI assessments made by conventional approaches to intraoperative findings of tear type, location, and size or MRI-assessed muscle occupation ratio. Methods: Intraoperatively, surgeons assessed tear type, location, anterior-posterior (AP) width, and medial-lateral length in 102 rotator cuff repair patients. Two musculoskeletal radiologists independently assessed the preoperative MRI scans for these same parameters and supraspinatus muscle atrophy by both Warner classification and quantitative occupation ratio. Exact agreement proportions, kappa statistics, and correlation coefficients were used to quantify agreement relationships. Results: Agreement between MRI readers’ and surgeons’ observations of tear status averaged 93% with κ = 0.38, and that of tear location averaged 77% with κ = 0.50. Concordance correlations of MRI and intraoperative measures of anterior-posterior and medial-lateral tear length averaged 0.59 and 0.56 across readers, respectively. Despite excellent interrater agreement on Warner classification (exact agreement proportion 0.91) and occupation ratio (concordance correlation 0.93) separately, correlations between these 2 measures were −0.54 and −0.64 for the 2 readers, respectively. Patients with Warner grade 0 had occupation ratios ranging from 0.5 to 1.5. Conclusion: Correlations of preoperative MRI tear dimensions and muscle atrophy assessed by conventional approaches with intraoperatively measured tear dimensions and quantitative occupation ratio, respectively, were only fair. Since tear size and muscle atrophy are known strong predictors of outcomes following rotator cuff repair that may influence treatment decisions, surgeons need to be aware of the limitations of MRI methods. Continued development and validation of quantitative preoperative imaging methods to accurately assess these parameters are needed to improve surgical planning and prognosis.

Published in JSES International

ISSN: 2666-6383 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/jses-international

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