title: Can Preoperative Magnetic Resonance Imaging Predict the Reparability of Massive Rotator Cuff Tears?
abstract: BACKGROUND
  Numerous studies have shown preoperative fatty infiltration of rotator cuff muscles to be strongly negatively correlated with the successful repair of massive rotator cuff tears (RCTs).
  
  
  OBJECTIVE
  To assess the association between factors identified on preoperative magnetic resonance imaging (MRI), especially infraspinatus fatty infiltration, and the reparability of massive RCTs.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  We analyzed a total of 105 patients with massive RCTs for whom MRI was performed ≤6 months before arthroscopic procedures. The mean age of the patients was 62.7 years (range, 46-83 years), and 46 were men. Among them, complete repair was possible in 50 patients (48%) and not possible in 55 patients (52%). The tangent sign, fatty infiltration of the rotator cuff, and Patte classification were evaluated as predictors of reparability. Using the receiver operating characteristic curve and the area under the curve (AUC), the prediction accuracy of each variable and combinations of variables were measured.
  
  
  RESULTS
  Reparability was associated with fatty infiltration of the supraspinatus ( P = .0045) and infraspinatus ( P < .001) muscles, the tangent sign ( P = .0033), and the Patte classification ( P < .001) but not with fatty infiltration of the subscapularis and teres minor ( P = .425 and .132, respectively). The cut-off values for supraspinatus and infraspinatus fatty infiltration were grade >3 and grade >2, respectively. The examination of single variables revealed that infraspinatus fatty infiltration showed the highest AUC value (0.812; sensitivity: 0.86; specificity: 0.76), while the tangent sign showed the lowest AUC value (0.626; sensitivity: 0.38; specificity: 0.87). Among 2-variable combinations, the combination of infraspinatus fatty infiltration and the Patte classification showed the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96). The combination of 4 variables, that is, infraspinatus and supraspinatus fatty infiltration, the tangent sign, and the Patte classification, had an AUC of 0.866 (sensitivity: 0.28; specificity: 0.98), which was lower than the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96) among the 2-variable combinations.
  
  
  CONCLUSIONS
  The tangent sign or Patte classification alone was not a predictive indicator of the reparability of massive RCTs. Among single variables, infraspinatus fatty infiltration was the most effective in predicting reparability, while the combination of Goutallier classification <3 of the infraspinatus and Patte classification ≤2 of the rotator cuff muscles was the most predictive among the combinations of variables. This information may help predict the reparability of massive RCTs.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea.|Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jung Youn
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Kyung Hee University Hospital, Seoul, Republic of Korea.
authors.forename: Ji Seon
authors.initials: JS
authors.lastname: Park
authors.affiliation: Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
authors.forename: Yong Girl
authors.initials: YG
authors.lastname: Rhee
mesh_terms: D000273:Adipose Tissue / Q000000981:diagnostic imaging; D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000379:methods; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000000981:diagnostic imaging; D057234:Preoperative Period; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000070636:Rotator Cuff Injuries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D012680:Sensitivity and Specificity
keywords: MRI; arthroscopic repair; massive rotator cuff tear; reparability; shoulder