title: Poor Agreement on Classification and Treatment of Subscapularis Tendon Tears.
abstract: OBJECTIVE
  To assess the inter- and intraobserver agreement for classification and management of subscapularis tendon pathology based on arthroscopy and magnetic resonance imaging (MRI).
  
  
  METHODS
  Twenty-two orthopaedic surgeons from the Multicenter Orthopaedic Outcomes Network (MOON) shoulder group reviewed still arthroscopic and MRI images of the subscapularis tendon from patients with a random assortment of subscapularis morphology. The surgeons were asked to classify the pathology based on 2 systems (Lafosse and Lyons) and choose whether they would repair the tendon and, if so, the method of repair (open or arthroscopic). The survey was administered 3 times to each surgeon. Inter- and intraobserver reliability between testing rounds was determined by kappa analysis.
  
  
  RESULTS
  Interobserver reliability on classification of tears was poor based on MRI (k = 0.18 to 0.19) and fair based on arthroscopy (k = 0.26 to 0.29). Interobserver agreement on whether surgical treatment was indicated was fair for both MRI (k = 0.28) and arthroscopy (k = 0.38), while the agreement for type of surgery was poor based on MRI (k = 0.18) and fair based on arthroscopy (k = 0.28). Interobserver agreement did not improve when both MRI and arthroscopy were provided simultaneously (k = 0.24 to 0.30). Intraobserver reliability for classification and treatment was fair to moderate for both MRI (k = 0.32 to 0.50) and arthroscopic imaging (k = 0.39 to 0.56). When considering just those patients with normal tendons, surgeon agreement improved. For all questions, the arthroscopic images had a higher level of agreement among surgeons than the MRI (P < .001).
  
  
  CONCLUSIONS
  Although surgeons tended to have higher reliability when presented with arthroscopic images compared with MRI, there was very little agreement on the classification and management of subscapularis tendon tears.
authors.affiliation: University of California, San Francisco, California, U.S.A.
authors.forename: Mia
authors.initials: M
authors.lastname: Smucny
authors.affiliation: University of California, San Francisco, California, U.S.A.
authors.forename: Edward C
authors.initials: EC
authors.lastname: Shin
authors.affiliation: University of California, San Francisco, California, U.S.A.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Zhang
authors.affiliation: University of California, San Francisco, California, U.S.A.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Feeley
authors.affiliation: University of California, San Francisco, California, U.S.A.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Gajiu
authors.affiliation: University of California, San Francisco, California, U.S.A.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Hall
authors.affiliation: University of California, San Francisco, California, U.S.A.. Electronic address: maben@orthosurg.ucsf.edu.
authors.forename: C Benjamin
authors.initials: CB
authors.lastname: Ma
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009985:Orthopedics; D015203:Reproducibility of Results; D012782:Shoulder / Q000473:pathology / Q000601:surgery*; D000070599:Shoulder Injuries; D011795:Surveys and Questionnaires; D013708:Tendon Injuries / Q000145:classification* / Q000473:pathology / Q000601:surgery*