Determination of rotator cuff tear reparability: An ultrasound-based investigation

Abstract Background The use of ultrasound as a viable diagnostic tool for routine office visit evaluation of rotator cuff integrity is slowly gaining acceptance in orthopedic practice. However, the reliability of accurately assessing rotator cuff tear reparability by ultrasound has limited evidence in the literature. The purpose of this study was to compare preoperative assessment of cuff tear reparability via ultrasound with the arthroscopic determination of reparability at the time of surgery. Materials and Methods We prospectively collected preoperative ultrasound and arthroscopic imaging data on 145 patients (80 or 55% male and average age of 60.7 years) who underwent arthroscopic posterior superior rotator cuff repair. Three independent experienced orthopedic surgeons retrospectively reviewed all ultrasound studies and arthroscopic imaging and determined if the posterior superior rotator cuff tendon edge was able to be viewed via ultrasound and determined with the arthroscopic images if the tear was reparable. Results Upon review of the ultrasound and arthroscopic data, if the edge of the rotator cuff tendon edge was able to be viewed on the coronal ultrasound image, it was most likely reparable with a positive predictive value (PPV) of 97.6% and a positive likelihood ratio (LR+) of 5.8. Sensitivity was 84.4% and specificity of 76.9%. The negative predictive value (NPV) was 37.5% and negative likelihood ratio (LR-) of 0.17. The interobserver reliability was 0.63 and the observers were unanimous in determining the tendon edge was able to be visualized in 99 of 145 cases (68%). Conclusions Preoperative ultrasound evaluation of the shoulder for posterior superior rotator cuff tears is a useful tool for assessing rotator cuff integrity and may help predict intraoperative reparability of the tendon. This study demonstrates that if the cuff tear edge is able to be visualized, there is a high probability of successful arthroscopic restoration of the tendon to its native attachment. Conversely, if the tear edge is unable to be visualized, there is a moderate chance of the tear being irreparable. These results help expand the knowledge base of the usefulness of in-office ultrasound performed by the surgeon in predicting the results of surgical intervention for rotator cuff tears.