Key result
Preoperative MRI demonstrated moderate concordance (48.9%, Kappa 0.489) with intraoperative findings for grading full-thickness rotator cuff tears, indicating tears may be more advanced at surgery.
Why the study?
The study aimed to compare preoperative MRI findings, shoulder tests, and intraoperative observations in patients undergoing arthroscopic rotator cuff repair to assess diagnostic accuracy.
Do preoperative MRI and shoulder-specific tests accurately predict intraoperative findings in patients with rotator cuff tears?
Observational (n=162)
No
Do preoperative MRI and shoulder-specific tests accurately predict intraoperative findings in patients with rotator cuff tears?
Effect estimate: Kappa 0.489
p-value: p=<0.001
Preoperative MRI and physical tests may underestimate the severity of rotator cuff tears compared to intraoperative findings, particularly for partial tears.
Caution advised interpreting preoperative MRI for partial rotator cuff tears; leaves open need for prospective imaging validation studies.
The aim of this study was to compare preoperative magnetic resonance imaging (MRI) findings, shoulder tests, and intraoperative observations in patients who underwent arthroscopic rotator cuff (RC) repair at a single center in Turkey. A total of 162 patients diagnosed with rotator cuff tears (RCTs) were included in this study. The physical examination involved the Jobe, Neer, and drop-arm tests. For patients undergoing shoulder arthroscopy, tear type and stage were evaluated intraoperatively and classified as partial-thickness or full-thickness tears. Preoperative assessments using MRI documented tear types and stages. Test results and imaging findings were compared to intraoperative observations to ensure diagnostic accuracy. A study of shoulder arthroscopy patients (129 right, 33 left; mean age 58.19 ± 9.20 years) found that 77.2% had full-thickness tears and 22.8% had partial tears on preoperative MRI. Significant differences were noted in the drop-arm test results (p = 0.003). MRI proved less reliable in localizing partial RCTs. Grade changes in full-thickness tears (Patte classification, p < 0.001) and partial tears (Ellman classification, p = 0.018) were statistically significant between preoperative and intraoperative evaluations. Certain specialized shoulder tests demonstrate strong diagnostic accuracy for specific conditions; however, their effectiveness may be limited when applied in isolation. MRI is a reliable tool for diagnosing RCTs; however, its sensitivity is reduced when detecting partial tears. This discrepancy suggests that both full-thickness and partial tears may exhibit more advanced pathology at the time of surgical intervention than initially indicated by preoperative imaging.
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Arikan et al. (2025) conducted an observational in Rotator cuff tears (n=162). Preoperative MRI and shoulder-specific tests vs. Intraoperative arthroscopic findings was evaluated on Concordance of Patte classification for full-thickness rotator cuff tears between preoperative MRI and intraoperative findings (Kappa 0.489, p=<0.001). Preoperative MRI demonstrated moderate concordance (48.9%, Kappa 0.489) with intraoperative findings for grading full-thickness rotator cuff tears, indicating tears may be more advanced at surgery.
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