Correlation of magnetic resonance and arthroscopy in the diagnosis of shoulder injury

High Sensitivity and Specificity of Magnetic Resonance Arthrography for Labral Tears, Rotator Cuff Tears, Hill-Sachs Lesions, and Bankart Lesions: A Systematic Review and Meta-analysis

PURPOSE

To compare the diagnostic value of magnetic resonance arthrography (MRA) in different shoulder lesions using arthroscopy as gold standard.

METHODS

We performed a comprehensive search in Cochrane, Scopus, PubMed, and Web of Science databases for articles that reported the diagnostic value of MRA in diagnosing labral tears, rotator cuff tears (RCTs), Hill-Sachs, and Bankart injuries. We used arthroscopic surgery as a reference standard for comparison. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. We pooled the collected data and used Stata/MP17 to generate summary statistics.

RESULTS

We identified a total of 53 articles compromising 5,487 patients. The sensitivity and specificity for Hill-Sachs lesions were 0.94 (95% confidence interval [CI] 0.80-0.99) and 0.89 (95% CI 0.77-0.95), Bankart lesions were 0.94 (95% CI 0.89-0.97) and 0.99 (95% CI 0.90-1.00), anterior labral tears were 0.91 (95% CI 0.82-0.96) and 0.96 (95% CI 0.90-0.99), posterior labral tears were 0.74 (95% CI 0.58-0.86) and 0.98 (95% CI 0.86-1.00), superior labral tears were 0.77 (95% CI 0.62-0.88) and 0.83 (95% CI 0.54-0.95), SLAP lesions were 0.86 (95% CI 0.80-0.90) and 0.91 (95% CI 0.83-0.96), partial-thickness RCTs were 0.67 (95% CI 0.45-0.83) and 0.92 (95% CI 0.78-0.97), whereas full-thickness RCTs were 0.97 (95% CI 0.91-0.99) and 0.99 (95% CI 0.93-1).

CONCLUSIONS

In conclusion, MRA is a sensitive and specific imaging method for identifying anterior labrum lesions, full-thickness RCTs, Bankart, SLAP, and Hill-Sachs lesions, with lower accuracy in partial-thickness RCTs, both posterior and superior labrum.

LEVEL OF EVIDENCE

Level III, meta-analysis of prospective and retrospective cohort and case-control studies.

The diagnostic value of MRI segmentation technique for shoulder joint injuries based on deep learning

This work is to investigate the diagnostic value of a deep learning-based magnetic resonance imaging (MRI) image segmentation (IS) technique for shoulder joint injuries (SJIs) in swimmers. A novel multi-scale feature fusion network (MSFFN) is developed by optimizing and integrating the AlexNet and U-Net algorithms for the segmentation of MRI images of the shoulder joint. The model is evaluated using metrics such as the Dice similarity coefficient (DSC), positive predictive value (PPV), and sensitivity (SE). A cohort of 52 swimmers with SJIs from Guangzhou Hospital serve as the subjects for this study, wherein the accuracy of the developed shoulder joint MRI IS model in diagnosing swimmers' SJIs is analyzed. The results reveal that the DSC for segmenting joint bones in MRI images based on the MSFFN algorithm is 92.65%, with PPV of 95.83% and SE of 96.30%. Similarly, the DSC for segmenting humerus bones in MRI images is 92.93%, with PPV of 95.56% and SE of 92.78%. The MRI IS algorithm exhibits an accuracy of 86.54% in diagnosing types of SJIs in swimmers, surpassing the conventional diagnostic accuracy of 71.15%. The consistency between the diagnostic results of complete tear, superior surface tear, inferior surface tear, and intratendinous tear of SJIs in swimmers and arthroscopic diagnostic results yield a Kappa value of 0.785 and an accuracy of 87.89%. These findings underscore the significant diagnostic value and potential of the MRI IS technique based on the MSFFN algorithm in diagnosing SJIs in swimmers.

Arthroscopic procedures for degenerative rotator cuff disease: a systematic review and network meta-analysis

BACKGROUND

Treatment of rotator cuff diseases often involves various arthroscopic procedures but their combined effectiveness remains contentious, especially in complex cases.

METHODS

We focused on patients with degenerative shoulder cuff diseases requiring arthroscopic rotator cuff repair. Searches covered multiple databases (Medline, Embase, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers) up to April 1, 2024. Bias risk was assessed using RevMan (v 5.4), and a network meta-analysis was conducted with netmeta (v 2.8).

RESULT

From 16 studies, 1232 patients (average age, 56.2 years; balanced sex ratio) were included. Arthroscopic rotator cuff repair ranked highest in functional score networks, surpassing other interventions. Physiotherapy was superior for pain relief compared to arthroscopic procedures combined with platelet-rich plasma (mean, 2.5; 95% confidence interval, 4.48-0.52). Arthroscopic rotator cuff repair and subacromial decompression were significantly superior to arthroscopic rotator cuff repair and subacromial decompression combined with platelet-rich plasma (MD, 1.80; 95% CI, 3.39-0.21).

DISCUSSION

Moderate bias risks were noted in both networks due to blinding issues and methodological quality reporting. Arthroscopic rotator cuff repair is favored for improving shoulder function, while other procedures or intra-articular treatments offer no significant benefits. Regarding pain management, physiotherapy is preferred; however, more evidence is needed to support this recommendation and caution is advised.

OTHER

Systematic review registration PROSPERO CRD42023450150.

The long head of biceps at the shoulder: a scoping review

BACKGROUND

This review aimed to explore the available literature to update our understanding of the long head of biceps (LHB) at the shoulder. Synthesise our findings to identify emergent themes and knowledge gaps to inform future research and management directions.

METHODS

PubMed, Embase, Cinahl, SportDiscus, CENTRAL, and Web of Science were searched from inception to 31st December 2021. Articles were included if they referenced adult participants > 18 years of age and were written in English.

RESULTS

214 articles were included in the final analysis, and results were categorised into six emergent themes: (1) Anatomy - Normal anatomical variation of the biceps from aberrant origins, third and fourth accessory heads, and an absence of the LHB tendon (LHBT) are not necessarily benign, with shoulder pain and instability a commonly reported theme. (2) Function - Bicep's role in glenohumeral elevation and stability in healthy shoulders is minimal. In contrast, LHB has a more significant role in shoulder stability and humeral head depression in subjects with rotator cuff failure or an absent LHBT. (3) Pathology - There is an association between LHB tendinopathy, rotator cuff disease, LHBT instability and occult rotator cuff tears. Early recruitment and hyperactivity of the LHB in subjects with symptomatic rotator cuff tears and instability suggest a potential compensatory role. (4) Assessment - The limited diagnostic utility of special orthopaedic tests in assessing LHBT pathology was a consistent theme. The utility of magnetic resonance imaging and ultrasound to identify full-thickness tendon tears and instability of the LHBT was moderate to high. However, the utility of clinical tests and imaging may be underestimated due to arthroscopy's limitations in fully visualising the proximal LHBT. (5) Non-Surgical Management - Ultrasound-guided injections into the biceps sheath show greater accuracy and patient outcomes than blinded injections; however, the entry of injectate into the intraarticular glenohumeral joint may have unwanted complications. (6) Surgical management - For the surgical management of biceps pathology with or without rotator cuff pathology, both biceps tenodesis and tenotomy report similar improvements in pain without any significant adverse effect on strength or function. Tenodesis favoured higher overall constant scores and a lower incidence of Popeye deformity and cramping arm pain, with tenotomy trending to be more cost and time effective. For patients with a healthy LHBT, rotator cuff repair with adjunctive tenodesis or tenotomy fails to provide additional clinical improvements compared to rotator cuff repair in isolation.

CONCLUSIONS

The scoping review highlights the variability of biceps anatomy, which is not necessarily benign and suggests a minimal role of the LHB in shoulder elevation and stability in healthy individuals. In contrast, individuals with rotator cuff tears experience proximal humeral migration and demonstrate hyperactivity of the LHB, suggesting a potential compensation role. The observed prevalence of LHBT pathology with rotator cuff tears is well established; however, the cause-and-effect relationship between LHBT pathology and rotator cuff disease is undetermined. The diagnostic utility of clinical tests and imaging to exclude LHBT pathology may be understated due to the limitations of arthroscopy to visualise the proximal LHBT fully. Rehabilitation programs for the LHB are understudied. Similar post-surgical clinical outcomes are observed for tenodesis and tenotomy for biceps and rotator cuff-related shoulder pain. Subjects undergoing biceps tenodesis are less likely to have cramping arm pain and a Popeye deformity than patients undergoing biceps tenotomy. The significance of routine surgical removal of the LHBT and sequelae on rotator cuff tear progression to failure and long-term shoulder function is unknown, and further research is required.

PRE-REGISTRATION

OSF: https://osf.io/erh9m.

Current Understanding and New Advances in the Surgical Management of Reparable Rotator Cuff Tears: A Scoping Review

Rotator cuff (RC) tears are among the most common musculoskeletal disorders and can be associated with pain, weakness, and shoulder dysfunction. In recent years, there have been significant advances with regard to the understanding of rotator cuff disease and its management. With technological improvements and advanced diagnostic modalities, there has been much progress as to improved understanding of the pathology. Similarly, with advanced implant designs and instrumentation, operative techniques have evolved. Furthermore, refinements in postoperative rehabilitation protocols have improved patient outcomes. In this scoping review, we aim to provide an overview of the current knowledge on the treatment of rotator cuff disorders and to highlight recent advances in its management.

Aktuelle Aspekte der Behandlung der Rotatorenmanschette

Rotatorenmanschettenrupturen gehören zu den häufigsten muskuloskeletalen Erkrankungen und können mit ausgeprägten Schmerzen und Funktionseinschränkungen einhergehen. Für ihre Entstehung ist eine Vielzahl von Faktoren relevant, u. a. die individuelle Anatomie des Akromions. Mit Hilfe der heutigen technischen Möglichkeiten wurde nun festgestellt, dass zusätzlich zu seiner lateralen Ausdehnung auch die sagittale Ausdehnung des Akromions eine Rolle zu spielen scheint. Die bildgebende Darstellung der Rotatorenmanschette (RM) hat von den technischen Fortschritten der letzten Jahrzehnte ebenfalls profitiert. Magnetresonanztomographie (MRT) und MR-Arthrographie werden heute flächendeckend eingesetzt. Letztere bietet die höchste Sensitivität für die Entdeckung selbst kleiner Partialläsionen. Neue Sequenzen und Nachbearbeitungsmöglichkeiten können als hilfreiche tools für die operative Planung eingesetzt werden. Grundsätzlich richtet sich die Behandlung der RM neben der Symptomatik nach der Rupturgenese und -morphologie sowie der erwarteten Gewebequalität des Muskel-Sehnen-Kontinuums. Auch das Gesamtprofil, die Erwartungshaltung und die Rehabilitationsmöglichkeiten des Patienten sind wichtig. Die heutigen operativen Techniken werden durch spannende Entwicklungen der Industrie mitbestimmt, die in den letzten Jahren immer bessere Fadenankersysteme, aber auch Augmentationsmaterialien auf den Markt gebracht hat. Letztere zielen nicht nur auf die mechanische Verstärkung der Sehnenrekonstruktion, sondern auch auf die Optimierung der biologischen Eigenschaften des Konstrukts ab. Hinsichtlich Fixation konnte die biomechanische Forschung zeigen, dass zweireihige oder Suture-Bridge-Fixationen einreihigen oder transossären Fixationen überlegen sind. Diese Überlegenheit im Labor spiegelt sich noch nicht klar in den klinischen Ergebnissen wider, dennoch sind die meisten Chirurgen heute auf diese Technik übergegangen. Was die postoperative Nachbehandlung angeht, stellen jüngste randomisiert-kontrollierte Untersuchungen das Konzept der postoperativen Immobilisation in Abduktion in Frage. Hier scheint das letzte Wort noch nicht gesprochen zu sein.