A comparison between preoperative and intraoperative rotator cuff tear size measurement and classification

Gill, Karl Peter, Bateman, Marcus, Mazuquin, Bruno ORCID: https://orcid.org/0000-0003-1566-9551 and Littlewood, Christopher ORCID: https://orcid.org/0000-0002-7703-727X (2023) A comparison between preoperative and intraoperative rotator cuff tear size measurement and classification. Brazilian Journal of Orthopaedics, 58 (2). pp. 356-360. ISSN 0102-3616

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Abstract

Purpose: To evaluate the agreement in tear size between pre-operative imaging and intra-operative measurement and to determine the accuracy of pre-operative imaging in the classification of tear size and identification of tears in each rotator cuff tendon. Methods: Data from 44 patients recruited to a randomised controlled trial were reviewed retrospectively. Rotator cuff tear size and location were confirmed by either ultrasound or magnetic resonance scans pre-operatively and evaluated during surgery. A t-test, Bland and Altman plot were used to determine agreement between pre-operative and intra-operative measurement. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for tear size and rotator cuff tendon involvement. Results: There was good agreement for tear size measurements (91%) and classification (89%) pre-operatively and during surgery. When classifying tear size, the sensitivity (and PPV) was high for medium-sized tears (100%) and lower for large tears (75%) reflecting that all medium-sized tears but not all large tears were identified pre-operatively. For the identification of tears pre-operatively sensitivity (and PPV) was highest for supraspinatus (84%) with progressively lower sensitivities (and PPV) for infraspinatus (57%), subscapularis (17%) and teres minor (0%). Conclusions: Pre-operative imaging can accurately measure or classify tear size. Where there is disagreement, it is unclear whether the tear size is either underestimated on the scan or overestimated during surgery. The high sensitivity demonstrates that a supraspinatus tear is usually detected by scan. The lower sensitivities for infraspinatus and subscapularis indicate that identification of tears in these tendons is less accurate.