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A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears
BACKGROUND: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. PURPOSE: To develop an assessment score reflecting factors in rotator cuff tears that can predi...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418268/ https://www.ncbi.nlm.nih.gov/pubmed/32844101 http://dx.doi.org/10.1177/2325967120940979 |
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author | Park, In Kang, Jun-Seok Lee, Hye-Ah Jo, Yoon-Geol Shin, Sang-Jin |
author_facet | Park, In Kang, Jun-Seok Lee, Hye-Ah Jo, Yoon-Geol Shin, Sang-Jin |
author_sort | Park, In |
collection | PubMed |
description | BACKGROUND: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. PURPOSE: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into “complete repair” and “partial repair” groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. RESULTS: The average rotator cuff tear size was 28 × 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969; P = .001), fatty infiltration of the infraspinatus of grade ≤2 (OR, 3.537; P = .001), coronal tear size ≥26 mm (OR, 3.315; P = .002), and remnant tendon length <15 mm (OR, 2.584; P = .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). CONCLUSION: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of ≥3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis. |
format | Online Article Text |
id | pubmed-7418268 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-74182682020-08-24 A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears Park, In Kang, Jun-Seok Lee, Hye-Ah Jo, Yoon-Geol Shin, Sang-Jin Orthop J Sports Med Article BACKGROUND: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. PURPOSE: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into “complete repair” and “partial repair” groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. RESULTS: The average rotator cuff tear size was 28 × 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969; P = .001), fatty infiltration of the infraspinatus of grade ≤2 (OR, 3.537; P = .001), coronal tear size ≥26 mm (OR, 3.315; P = .002), and remnant tendon length <15 mm (OR, 2.584; P = .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). CONCLUSION: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of ≥3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis. SAGE Publications 2020-08-07 /pmc/articles/PMC7418268/ /pubmed/32844101 http://dx.doi.org/10.1177/2325967120940979 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Article Park, In Kang, Jun-Seok Lee, Hye-Ah Jo, Yoon-Geol Shin, Sang-Jin A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears |
title | A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears |
title_full | A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears |
title_fullStr | A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears |
title_full_unstemmed | A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears |
title_short | A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears |
title_sort | novel reparability assessment scoring system for full-thickness rotator cuff tears |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418268/ https://www.ncbi.nlm.nih.gov/pubmed/32844101 http://dx.doi.org/10.1177/2325967120940979 |
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