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

doi:10.1016/j.jseint.2022.08.014

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

JSES Int. 2022 Sep 14;6(6):948-956. doi: 10.1016/j.jseint.2022.08.014. eCollection 2022 Nov.

Authors

Jinjin Ma^{1

2}, Sambit Sahoo^{1

2}, Peter B Imrey^{3

4}, Yuxuan Jin³, Andrew R Baker¹, Vahid Entezari², Jason C Ho², Mark S Schickendantz², Lutul D Farrow², Alfred Serna², Joseph P Iannotti², Eric T Ricchetti², Joshua M Polster⁵, Carl S Winalski^{1

5}, Kathleen A Derwin^{1

2}

Affiliations

¹ Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
² Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
³ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
⁴ Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
⁵ Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA.

Abstract

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.

Keywords: Inter-rater agreement; Intraoperative assessment; MR imaging; Muscle atrophy; Occupation ratio; Rotator cuff repair; Tear characteristics; Warner classification.