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Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff

BACKGROUND: The most common complication of arthroscopic rotator cuff repair is retear, which is more common in larger tears and older patients. We hypothesized that the quality of the torn tendon is important in protecting against retear. Surgeons have traditionally assessed the quality of repaired...

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Autores principales: Maloof, Alexander G., Hackett, Lisa, Lam, Patrick H., Murrell, George A.C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10229420/
https://www.ncbi.nlm.nih.gov/pubmed/37266179
http://dx.doi.org/10.1016/j.jseint.2023.02.005
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author Maloof, Alexander G.
Hackett, Lisa
Lam, Patrick H.
Murrell, George A.C.
author_facet Maloof, Alexander G.
Hackett, Lisa
Lam, Patrick H.
Murrell, George A.C.
author_sort Maloof, Alexander G.
collection PubMed
description BACKGROUND: The most common complication of arthroscopic rotator cuff repair is retear, which is more common in larger tears and older patients. We hypothesized that the quality of the torn tendon is important in protecting against retear. Surgeons have traditionally assessed the quality of repaired tendons with a four-point Likert scale. Shear Wave Elastography Ultrasound (SWEUS) is a recent technological advancement that can quantify soft-tissue stiffness. This study aimed to determine how closely a surgeon’s intraoperative ranking of tissue quality during rotator cuff repair correlated to postoperative supraspinatus tendon stiffness measured by SWEUS. METHODS: This was a prospective case series on 50 patients undergoing arthroscopic rotator cuff repair, involving SWEUS measurements of each patient’s supraspinatus tendon at 8 days, 6 weeks, 12 weeks, 6 months, and 12 months. The intraoperative surgeon score of tissue quality for each patient was ranked on a four-point Likert scale. Each patient’s scores were compared to postoperative SWEUS velocity measurements of the supraspinatus tendon postrepair. RESULTS: The SWEUS determined stiffness of supraspinatus tendons at their repaired insertion site postrepair increased by 22% from 6.3 ± 0.2 m/s to 7.7 ± 0.3 m/s over 12 months as the tendons healed (P = .0001). Supraspinatus tendon stiffness was greater in patients with smaller tears (r = −0.50, P = .001) and of younger age (r = −0.58, P = .00001). Surgeons also consistently rated younger patients (r(s) = −0.49, P = .0001) and smaller tears (r(s) = −0.56, P = .00001) as having superior intraoperative tendon quality. The correlations between SWEUS velocity and surgeon tissue quality rankings were modest at best and strongest at 12 weeks (r(s) = 0.27, P = .04). There were modest associations between SWEUS tendon stiffness and surgeon tendon mobility rankings at 6 weeks (r(s) = 0.26, P = .04) and repair quality rankings at 12 months (r(s) = 0.36, P = .02). CONCLUSIONS: These data support the finding that machines (SWEUS) are better at assessing torn rotator cuff tendon quality and whether that tendon will heal after repair than the ‘person’ performing the surgery. Supraspinatus tendons lose stiffness as they get older and when the tear is larger, likely explaining why retear post-cuff repair is more common with advanced age and larger tears.
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spelling pubmed-102294202023-06-01 Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff Maloof, Alexander G. Hackett, Lisa Lam, Patrick H. Murrell, George A.C. JSES Int Shoulder BACKGROUND: The most common complication of arthroscopic rotator cuff repair is retear, which is more common in larger tears and older patients. We hypothesized that the quality of the torn tendon is important in protecting against retear. Surgeons have traditionally assessed the quality of repaired tendons with a four-point Likert scale. Shear Wave Elastography Ultrasound (SWEUS) is a recent technological advancement that can quantify soft-tissue stiffness. This study aimed to determine how closely a surgeon’s intraoperative ranking of tissue quality during rotator cuff repair correlated to postoperative supraspinatus tendon stiffness measured by SWEUS. METHODS: This was a prospective case series on 50 patients undergoing arthroscopic rotator cuff repair, involving SWEUS measurements of each patient’s supraspinatus tendon at 8 days, 6 weeks, 12 weeks, 6 months, and 12 months. The intraoperative surgeon score of tissue quality for each patient was ranked on a four-point Likert scale. Each patient’s scores were compared to postoperative SWEUS velocity measurements of the supraspinatus tendon postrepair. RESULTS: The SWEUS determined stiffness of supraspinatus tendons at their repaired insertion site postrepair increased by 22% from 6.3 ± 0.2 m/s to 7.7 ± 0.3 m/s over 12 months as the tendons healed (P = .0001). Supraspinatus tendon stiffness was greater in patients with smaller tears (r = −0.50, P = .001) and of younger age (r = −0.58, P = .00001). Surgeons also consistently rated younger patients (r(s) = −0.49, P = .0001) and smaller tears (r(s) = −0.56, P = .00001) as having superior intraoperative tendon quality. The correlations between SWEUS velocity and surgeon tissue quality rankings were modest at best and strongest at 12 weeks (r(s) = 0.27, P = .04). There were modest associations between SWEUS tendon stiffness and surgeon tendon mobility rankings at 6 weeks (r(s) = 0.26, P = .04) and repair quality rankings at 12 months (r(s) = 0.36, P = .02). CONCLUSIONS: These data support the finding that machines (SWEUS) are better at assessing torn rotator cuff tendon quality and whether that tendon will heal after repair than the ‘person’ performing the surgery. Supraspinatus tendons lose stiffness as they get older and when the tear is larger, likely explaining why retear post-cuff repair is more common with advanced age and larger tears. Elsevier 2023-03-05 /pmc/articles/PMC10229420/ /pubmed/37266179 http://dx.doi.org/10.1016/j.jseint.2023.02.005 Text en © 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Shoulder
Maloof, Alexander G.
Hackett, Lisa
Lam, Patrick H.
Murrell, George A.C.
Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
title Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
title_full Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
title_fullStr Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
title_full_unstemmed Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
title_short Man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
title_sort man vs. machine: surgeon vs. elastography assessment of the quality of the rotator cuff
topic Shoulder
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10229420/
https://www.ncbi.nlm.nih.gov/pubmed/37266179
http://dx.doi.org/10.1016/j.jseint.2023.02.005
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