Re-tear after arthroscopic rotator cuff tear surgery: risk analysis using machine learning

Abstract

Postoperative rotator cuff re-tear after arthroscopic rotator cuff repair (ARCR) is still a major problem. Various risk factors such as age, gender, and tear size have been reported. Recently, magnetic resonance imaging (MRI)-based stump classification was reported as an index of rotator cuff fragility. Although stump type 3 is reported to have a high re-tear rate, there are few reports on the risk of postoperative re-tear based on this classification. Machine learning (ML), an artificial intelligence technique, allows for more flexible predictive models than conventional statistical methods and has been applied to predict clinical outcomes. In this study, we used ML to predict postoperative re-tear risk after ARCR. The retrospective case-control study included 353 patients who underwent surgical treatment for complete rotator cuff tear using the suture-bridge technique. Patients who initially presented with re-tears and traumatic tears were excluded. In study participants, after the initial tear repair, rotator cuff re-tears were diagnosed by MRI; Sugaya classification types IV and V were defined as re-tears. Age, gender, stump classification, tear size, Goutallier classification, presence of diabetes, and hyperlipidemia were used for ML parameters to predict the risk of re-tear. Using Python's Scikit-learn as an ML library, five different AI models (logistic regression, random forest, AdaBoost, CatBoost, LightGBM) were trained on the existing data, and the prediction models were applied to the test dataset. The performance of these ML models was measured by the area under the receiver operating characteristic curve (AUC). Additionally, key features affecting re-tear were evaluated. The AUC for logistic regression was 0.78, random forest 0.82, AdaBoost 0.78, CatBoost 0.83, and LightGBM 0.87, respectively for each model. LightGBM showed the highest score. The important factors for model prediction were age, stump classification, and tear size. The ML classifier model predicted re-tears after ARCR with high accuracy, and the AI model showed that the most important characteristics affecting re-tears were age and imaging findings, including stump classification. This model may be able to predict postoperative rotator cuff re-tears based on clinical features. Prognosis Study (Case-control study).