Correlation of Arthroscopic Repairability of Large to Massive Rotator Cuff Tears With Preoperative Magnetic Resonance Imaging Scans

PurposeThe purpose of this study was to determine whether there are preoperative magnetic resonance imaging (MRI) variables that could predict the repairability of large to massive rotator cuff tears (RCTs), especially in terms of distinguishing between complete repair and incomplete repair.MethodsFifty-one consecutive patients who had large to massive RCTs were treated by arthroscopic repair with suture anchors. The primary repair was subclassified into 4 types. Types I and II were complete repairs with coverage of the lateral end of the greater tuberosity footprint (type I) or to the medial one half or less of the footprint (type II). Types III and IV were incomplete repairs with either small exposure of the humeral head (<10 mm) (type III) or moderate exposure of the head with repair of the force couple of the rotator cuff (type IV). Six preoperative MRI measurements (fatty degeneration index [FDI] in all planes, occupational grade, tangent sign, coronal oblique tear distance [COTD], sagittal oblique tear distance [SOTD], and coronal oblique thickness) that were reported in the previous literature were examined. These measurements were correlated with our classification of repair.ResultsThere were 28 large and 23 massive tears. Interobserver reproducibility was good to excellent. When we compared the completely and incompletely repaired groups, the FDI values for sagittal oblique sections of the supraspinatus and the infraspinatus and the FDI values for COTD and SOTD showed statistically significant differences. The cutoff values for SOTD and COTD were 32 mm and 31 mm, respectively. Regarding FDI, values greater than 3 on sagittal oblique sections of the supraspinatus and greater than 2 on sagittal oblique sections of the infraspinatus can be discouraging findings for complete repair.ConclusionsOn preoperative MRI of RCTs, FDI values of greater than 3 on sagittal oblique sections of the supraspinatus and greater than 2 on sagittal oblique sections of the infraspinatus with greater than 31 mm in COTD and 32 mm in SOTD can imply incomplete arthroscopic repair of the torn tendon or type III/IV repair.Level of EvidenceLevel II, development of diagnostic criteria based on consecutive patients with universally applied gold standard.