A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair

In vivo shoulder kinematic changes and rotator cuff healing after surgical repair of large-to-massive rotator cuff tears

BACKGROUND

Few studies have investigated the correlation between shoulder kinematics and clinical outcomes in patients undergoing rotator cuff repair using dynamic analysis. This study assessed shoulder kinematics before and after surgical repair in patients with rotator cuff tears (RCTs) and determined the relationship among shoulder kinematics and between shoulder kinematics and clinical outcomes.

METHODS

Ten patients with large-to-massive RCTs and 10 control participants were included. In vivo shoulder kinematics during scapular plane abduction were measured preoperatively and 1 year postoperatively using validated image-registration techniques and compared among the control, preoperative, and postoperative groups. Mixed models were used to compare the effects of the groups on shoulder kinematics, followed by Tukey's honest significant difference test. Pearson's correlation coefficient was used to identify the correlations among shoulder kinematics and between each kinematic and clinical outcome.

RESULTS

The scapula, tilted more anteriorly preoperatively, was not different from the control group postoperatively. Additionally, the change in scapular posterior tilt (PT) throughout dynamic abduction was 18.17° ± 3.59° in the postoperative group, greater than that in the control group (11.54° ± 2.29°; p = 0.0037). The postoperative change in PT significantly correlated with acromiohumeral distance (AHD) and rotator cuff integrity (Sugaya classification) (AHD: r = 0.71, p = 0.023; Sugaya classification: r = - 0.75, p = 0.013), but not preoperative change in PT. Functional score improved from preoperative to postoperative (p < 0.0001). Abduction angle and functional score significantly correlated with Sugaya classification (abduction angle: r = - 0.67, p = 0.034; functional score: r = - 0.70, p = 0.025) but not with shoulder kinematics. Mean superior translation of the humeral head and AHD throughout abduction changed from 1.77 ± 1.34 to 0.61 ± 1.37 and 1.44 ± 1.59 to 2.71 ± 2.27 mm, respectively, from preoperative to postoperative (both p < 0.0001).

CONCLUSIONS

After the surgical repair of large-to-massive RCTs, glenohumeral stability normalized, and the more anteriorly tilted orientation of the scapula improved. Additionally, the preoperative increased scapular motion throughout dynamic abduction was further enhanced postoperatively. Interestingly, in postoperative patients, scapular motion toward PT during dynamic abduction correlated with minimum AHD and cuff healing.

The relationship between the shape of rotator cuff tears and shoulder anatomical parameters

BACKGROUND

The aim of this study is to investigate the potential relationship between shoulder anatomical parameters and the shape of rotator cuff tears (L-shaped, U-shaped, and crescent-shaped).

MATERIALS AND METHODS

The study included 160 (n:160) patients. Patients were divided into four groups: crescent type, u type and L type tears and control group. There were 40 cases in each group. The operated patients were divided into three groups based on the shape of the tears in arthroscopic images. Measurements of Critical Shoulder Angle (CSA), Greater Tuberosity Angle (GTA), Acromion Index (AI), Lateral Acromion Angle (LAA), and Humerus Footprint width (coronal width and sagittal width) were taken in each group and compared.

RESULTS

Patients were divided into four different groups: Crescent type group (n:40), L type group (n:40), U type group (n:40) and control group (n:40). Upon assessing the coronal and sagittal width measurements, The mean coranal width measurement of the L-type tear group was 12.62 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). The mean sagittal width of the L-type tear group was 34.95 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on GTA, CSA, and AI data, the mean GTA measurement of the L-type tear group was 73.03 ± 0.95 degrees, which was significantly higher than all other groups (p < 0.05). The mean CSA measurement of the L-type tear group was 34.77 ± 0.66 degrees, which was significantly higher than all other groups (p < 0.05). The mean AI measurement of the L-type tear group was 0.77 ± 0.02, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on LAA data, the mean LAA measurement of the L-type tear group was 76.98 ± 1.04 degrees, which was significantly lower than all other groups (p < 0.05).

CONCLUSION

In our study, especially in L-shaped tears, measurements of GTA, CSA, AI, LAA, coronal and sagittal width were found to be different compared to the control group. These results suggest that shoulder anatomy affects the mechanisms of rotator cuff tear formation and that these parameters play a more significant role in L-shaped tears.

Changes in the Lateral Acromion Angle in Rotator Cuff Tear Patients with Acromioplasty

BACKGROUND

Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the modifications in the lateral acromial angle (LAA) subsequent to rotator cuff repair surgery using single-row rivet fixation and double-row rivet fixation techniques. Furthermore, we sought to investigate the influence of LAA on the prognosis of rotator cuff repair surgery.

METHOD

This observational study retrospectively enrolled 105 patients diagnosed with degenerative rotator cuff tears who underwent arthroscopic rotator cuff repair between 2016 and 2019. Following the exclusion of two patients with subscapularis or superior labrum anterior and posterior (SLAP) tears, as well as three patients who were lost to follow-up, a cohort of 100 patients was included for clinical and imaging evaluation. Among these individuals, 50 were assigned to the double-row repair group, whereas the remaining 50 comprised the single-row repair group. Bilateral shoulder magnetic resonance imaging (MRI) scans were conducted no less than 24 months post-surgery. Experienced arthroscopic surgeons, blinded to the LAA measurements, assessed the rotator interval (RI) using a control MRI. Functional assessment was performed using the University of California, Los Angeles (UCLA) quick disability of the shoulder and arm, shoulder and hand (qDASH) score. The Wilcoxon signed-rank test for dependent samples was employed to compare data between the pre- and post-intervention groups. Pearson correlation coefficients were calculated to evaluate the relationship between different parameters.

RESULTS

The study population consisted of 73 female patients and 27 male patients, with a mean age of 58.32 ± 5.29 years and a mean follow-up duration of 25.88 ± 8.11 months. Preoperatively, the mean LAA was 75.81° ± 11.28°, RI was 4.78 ± 0.62, UCLA score was 17.54 ± 2.44, and qDASH score was 2.45 ± 0.25. The average tear size was 8.95 ± 2.11 mm. A statistically significant difference in LAA was observed between the preoperative and postoperative measurements, with the double-row repair group exhibiting a greater LAA than the single-row repair group. Finally, a significant correlation was identified between LAA, RI, and qDASH scores after a 24-month follow-up period.

CONCLUSION

According to our findings, the utilization of double-row rivet fixation has a greater LAA angle than single-row rivet fixation. Moreover, this preservation of LAA is significantly associated with the functional recovery of the shoulder joint.

Prediction of Retear After Arthroscopic Rotator Cuff Repair Based on Intraoperative Arthroscopic Images Using Deep Learning

BACKGROUND

It is challenging to predict retear after arthroscopic rotator cuff repair (ARCR). The usefulness of arthroscopic intraoperative images as predictors of the ARCR prognosis has not been analyzed.

PURPOSE

To evaluate the usefulness of arthroscopic images for the prediction of retear after ARCR using deep learning (DL) algorithms.

STUDY DESIGN

Cohort study (Diagnosis); Level of evidence, 2.

METHODS

In total, 1394 arthroscopic intraoperative images were retrospectively obtained from 580 patients. Repaired tendon integrity was evaluated using magnetic resonance imaging performed within 2 years after surgery. Images obtained immediately after ARCR were included. We used 3 DL architectures to predict retear based on arthroscopic images. Three pretrained DL algorithms (VGG16, DenseNet, and Xception) were used for transfer learning. Training and test sets were split into 8:2. Threefold stratified validation was used to fine-tune the hyperparameters using the training data set. The validation results of each fold were evaluated. The performance of each model in the test set was evaluated in terms of accuracy, area under the receiver operating characteristic curve (AUC), F1-score, sensitivity, and specificity.

RESULTS

In total, 1138 and 256 arthroscopic images were obtained from 514 patients and 66 patients in the nonretear and retear groups, respectively. The mean validation accuracy of each model was 83% for VGG16, 89% for Xception, and 91% for DenseNet. The accuracy for the test set was 76% for VGG16, 87% for Xception, and 91% for DenseNet. The AUC was highest for DenseNet (0.92); it was 0.83 for VGG16 and 0.91 for Xception. For the test set, the specificity and sensitivity were 0.93 and 0.84 for DenseNet, 0.89 and 0.84 for Xception, and 0.70 and 0.80 for VGG16, respectively.

CONCLUSION

The application of DL algorithms to intraoperative arthroscopic images has demonstrated a high level of accuracy in predicting retear occurrences.