Description
Purpose:
Assessing the reparability of rotator cuff tears before surgery is crucial to inform surgical decision-making and predict the likelihood of successful repair. Traditional methods have limitations, necessitating the introduction of a novel approach. This study focuses on the deep layer attachment of the rotator cuff at the medial edge of the greater tuberosity, aiming to revolutionize our understanding of rotator cuff tears and enhance patient outcomes.
Methods:
We retrospectively analyzed preoperative MRI data from 198 patients who underwent ARCR with long-massive rotator cuff tears to evaluate the extent of deep layer tears. Proton images were employed to precisely assess the anterior attachment position of the deep layer in the oblique sagittal plane. Within the imaging slice traversing the lateral margin of the articular cartilage, a circle was drawn to match the humeral head, from which two lines were extended - one to the posterior edge of the long head of the biceps and the other reaching the anteriormost part of the deep layer attachment. The angle formed by these lines, termed the "shift angle," was measured (Figure 1). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to measure their accuracy for intraoperative reparability of rotator cuff tears.
Results
Our results showed that 169 of 198 tears were reparable and 29 irreparable. Reparable tears had a significantly lower shift angle (78.1±26.1 vs. 114.3±14.5), p<0.001). The cut-off value for the shift angle was 98.0 (95%CI. 0.799-0.921) with a specificity and sensitivity of 0.862 and 0.709, respectively. The AUC of the ROC curve was 0.860.
Conclusion.
The shift angle, employed to assess the size of the deep layer tear, emerges as a valuable predictor of intraoperative rotator cuff reparability. This novel approach may contribute to the advancement of our understanding of rotator cuff tears, particularly in the context of the deep layer of the tendon, leading to more informed surgical decisions and improved patient outcomes.
