Abstract
BackgroundPartial thickness supraspinatus tears and tendonosis can be managed either nonoperatively or by various arthroscopic techniques. New biologic treatment approaches are currently being investigated. MRI is commonly used for objective imaging outcome evaluation but there is a lack of reliability studies. We propose a novel MRI classification of partial supraspinatus tears and tendonosis and evaluate its inter-observer and intra-observer reliability.MethodsDigital MRI scans (3 Tesla) of 65 patients investigated for assessment of supraspinatus pathology or subacromial impingement were evaluated by three independent and experienced musculoskeletal (MSK) radiologists. Tendonosis (absent, focal, generalized), partial thickness (PT) tears (absent, 0%–25% PT, 25%–50% PT, 50%–100% PT, and full thickness tears), and anteroposterior extent of tears (less than 5 mm, 5–10 mm, greater than 10 mm) were scored by each radiologist on two separate occasions (t1, t2), 2 months apart. The inter-observer and intra-observer agreement and weighted kappa values for each parameter were calculated.ResultsThe range of weighted intra-observer kappa (IAK) was 0.84–0.93 for evaluation of tendonosis; 0.84 (all raters) for depth of partial thickness, 0.74–0.84 for AP tear size, and 0.83–0.85 for the total score. The range of weighted inter-observer kappa (IEK) over two time points (t1, t2) was 0.55–0.74 for tendonosis, 0.69–0.84 for depth for partial thickness tears, 0.57–0.80 for AP tear size, and 0.63–0.80 for the total score.ConclusionA comprehensive MRI grading protocol is proposed and is reliable for the evaluation of supraspinatus tendonosis and partial thickness tears with good to excellent kappa values. This rotator cuff MRI protocol can be applied to evaluate morphological tendon outcomes after different treatment modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s13018-014-0128-x) contains supplementary material, which is available to authorized users.
Highlights
Rotator cuff pathology varies from tendonosis and partial thickness tears, to full thickness tendon tears and in some cases, progression to rotator cuff arthropathy
This protocol takes into account that tendonopathy can include partial thickness tears of varying extent which can occur in conjunction with focal or generalized tendonosis
The protocol refines assessment of the extent of partial tendon tearing, separately scoring tendon tear thickness and tear extent in the AP direction. This MRI protocol differentiates partial thickness tears to a greater extent compared to previous studies, which have looked at partial tears in the coronal
Summary
Rotator cuff pathology varies from tendonosis and partial thickness tears, to full thickness tendon tears and in some cases, progression to rotator cuff arthropathy. Rotator cuff disease can be divided into rotator cuff tendonopathy (including external and internal impingement, tendonitis, tendinosis with degeneration, and partial thickness tendon tears) and full thickness tears [4]. Tendonosis and partial thickness cuff injuries are prevalent in heavy sporting activity and in middle age [5]. They tend to increase with age, supporting the contribution of tendon degeneration as an important causative factor [4]. To evaluate the treatment outcome, or compare the efficacy of different treatments for partial thickness supraspinatus tears, an objective and reliable measure of supraspinatus tendon healing is required. We propose a novel MRI classification of partial supraspinatus tears and tendonosis and evaluate its inter-observer and intra-observer reliability
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