CT Arthrography Research Articles

Clinical outcomes and structural integrity of C-shaped rotator cuff tears after arthroscopic repair: comparison with crescent-shaped tears

BackgroundWe aimed to describe a new C-shaped tear configuration, and to compare clinical outcomes and structural integrity between the C-shaped and the established crescent-shaped small to medium-sized rotator cuff tears after arthroscopic repair.MethodsThis retrospective study included 102 patients who underwent arthroscopic repair in a single-row fashion for small- to medium-sized rotator cuff tears of either C or crescent shape from March 2009 to June 2014. Visual analogue scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeon (ASES) score, and active range of motion (ROM) were evaluated for functional outcomes. Postoperative magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed 6 months postoperatively to assess structural integrity.ResultsAfter 2 years of follow-up, both groups showed no significant difference in VAS pain score, functional scores, or ROM, although the C-shaped tear group exhibited significantly inferior outcomes 3 months after surgery. There was no significant difference in the re-tear rate on follow-up MRA and CTA between groups A and B (24.4 vs. 19.7%, respectively; p = 0.570). The postoperative stiffness rate was significantly higher in the C-shaped tear group than that in crescent-shaped tear group only at 3-month follow-up point after surgery (26.8 vs. 9.8%, respectively; p = 0.024).ConclusionsContrary to our hypothesis, there were no significant differences in functional outcomes and structural integrity between C-shaped and crescent-shaped small- to medium-sized tears 2 years after arthroscopic repair. However, C-shaped tears exhibited significantly worse clinical outcomes, including a higher postoperative stiffness rate than crescent-shaped tears in the early postoperative period at the 3-month follow-up point.

A prototype assembled 3D-printed phantom of the glenohumeral joint for fluoroscopic-guided shoulder arthrography

To describe the methodology of constructing a three-dimensional (3D) printed model of the glenohumeral joint, to serve as an interventional phantom for fluoroscopy-guided shoulder arthrography training. The osseous structures, intra-articular space and skin surface of the shoulder were digitally extracted as separate 3D meshes from a normal CT arthrogram of the shoulder, using commercially available software. The osseous structures were 3D-printed in gypsum, a fluoroscopically radiopaque mineral, using binder jet technology. The joint capsule was 3D printed with rubber-like TangoPlus material, using PolyJet technology. The capsule was secured to the humeral head and glenoid to create a sealed intra-articular space. A polyamide mold of the skin was printed using selective laser sintering. The joint was stabilized inside the mold, and the surrounding soft tissues were cast in silicone of varying densities. Fluoroscopically-guided shoulder arthrography was performed using anterior, posterior, and rotator interval approaches. CT arthrographic imaging of the phantom was also performed. A life-size phantom of the glenohumeral joint was constructed. The radiopaque osseous structures replicated in-vivo osseous corticomedullary differentiation, with dense cortical bone and less dense medullary cancellous bone. The glenoid labrum was successfully integrated into the printed capsule, and visualized on CT arthrography. The phantom was repeatedly used to perform shoulder arthrography using all three conventional approaches, and simulated the in vivo challenges of needle guidance. 3D printing of a complex capsule, such as the glenohumeral joint, is possible with this technique. Such a model can serve as a valuable training tool.

Scapholunate instability: improved detection with semi-automated kinematic CT analysis during stress maneuvers.

To evaluate the diagnostic performance of radioulnar deviation (RUD) and clenching fist (CF) maneuvers for the evaluation of scapholunate dissociation (SLD) using quantitative kinematic CT. Thirty-seven patients with suspected scapholunate instability were prospectively evaluated with kinematic CT. Two radiologists independently evaluated the SLD during RUD and CF maneuvers. Various dynamic parameters describing SLD were compared (maximal value, variation coefficient and range) in patients with and without scapholunate ligament ruptures confirmed by CT arthrography. SLD in CF varied from 3.17 ± 0.38 to 3.24 ± 0.80 mm in controls and from 4.11 ± 0.77 and 4.01 ± 0.85 mm in patients with scapholunate ligament ruptures for reader 1 and 2 (p < 0.009). SLD in RUD varied from 3.35 ± 0.51 and 3.01 ± 0.78 mm in controls and from 4.51 ± 1.26 to 4.42 ± 1.75 mm in patients with scapholunate ligament ruptures for reader 1 and 2 (p varied from 0.001 to 0.002). The inter-observer variability was better for RUD (ICC = 0.85 versus 0.6 for RUD and CF respectively). Analysis of SLD using kinematic CT has shown significant measurement differences between the groups with or without scapholunate instability with good diagnostic performance. • Kinematic CT can quantitatively assess scapholunate dissociation. • SLD analysis on kinematic CT has excellent reproducibility with radioulnar deviation maneuver. • Scapholunate dissociation was significantly different in patients with and without instability. • Diagnostic performance for scapholunate instability identification was better with radioulnar deviation.

Predictors of Pain and Discomfort Associated with CT Arthrography of the Shoulder

The objective of this study was to investigate predictors of pain associated with computed tomographic arthrography of the shoulder. Before shoulder arthrography, all participants were assessed with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life Short Version Instrument (WHOQOL-BREF). The participants were nonrandomized into two groups: the anesthesia group, who underwent prior local infiltration anesthesia before shoulder arthrography, and the nonanesthesia group, who did not undergo prior local infiltration anesthesia. The pain levels at intraprocedure, at 1, 2, 6, and 12 hours, and at 1 and 2 days after injection were assessed by using a visual analog scale. Univariate and multivariate generalized linear model analyses were conducted. Sixty participants in the anesthesia group and 60 participants in the nonanesthesia group were included. The pain level at intraprocedure (3.37 ± 1.94 in the anesthesia group and 3.20 ± 1.34 in the nonanesthesia group) was the highest of the whole pain course. The psychological domain (P = .0013) of WHOQOL-BREF, gender (P = .042), body mass index (P = .0001), and the total number of reinsertion and redirection of needle (P< .0001) were independent predictors of arthrography-related pain. The pain associated with shoulder computed tomographic arthrography depends on the psychological domain of WHOQOL-BREF, gender, body mass index, and the total number of reinsertion and redirection of needle.

The value of multi-detector CT arthrography of the wrist joint in evaluation of ligamentous and capsular injuries in post-traumatic pain

The wrist joint is a complex joint containing several intrinsic and extrinsic ligaments that contribute to carpal stability. There is increased incidence of ligamentous/capsular injury following trauma. ObjectiveThe aim of this study was to assess the value of high resolution MDCT arthrography in detection of various ligamentous and capsular injuries of the wrist in post-traumatic writ pain. Patients and methodsFrom August 2016 to February 2017 Seventeen patients with posttraumatic wrist pain underwent MDCT arthrography primarily through radiocarpal injection and using high resolution study, all patients have negative MRI study of the wrist. Results59% of cases had ligamentous/capsular tear. The most frequent was the capsular tears. Incomplete intrinsic ligament tears were observed, the dorsal scaphotrapezio-trapezoid ligament was the commonest to be affected. Class IA traumatic TFC tear was found in 12%. There was significant high positive correlation between the VAS score for wrist pain and the presence of ligamentous/capsular tear in absence of bone fracture. ConclusionMDCT arthrography of the wrist is an excellent imaging method that can detect MRI occult ligamentous tear in unexplained post traumatic pain.

Subchondral bone/cartilage: a functional unit? Bone density and cartilage thickness are positively correlated in non osteoarthritic and negatively correlated in osteoarthritic knees - a combined 3D analysis using ct arthrography

Subchondral bone/cartilage: a functional unit? Bone density and cartilage thickness are positively correlated in non osteoarthritic and negatively correlated in osteoarthritic knees - a combined 3D analysis using ct arthrography

Cartilage Imaging: Techniques and Developments.

Cartilage degeneration is one of the most common chronic age-related joint disorders leading to pain and reduced joint motion. The increasing prevalence of osteoarthritis requires accurate cartilage imaging, both clinically and in research. Detailed cartilage imaging is also necessary for traumatic cartilage lesions and for pre- and postoperative assessment of cartilage repair procedures. Although still widely used, conventional radiography bears significant limitations because it assesses cartilage indirectly by joint space width. Magnetic resonance imaging (MRI) enables direct visualization of cartilage damage along with other concomitantly affected joint tissues. Several semiquantitative grading systems and volumetric analysis methods exist to assess cartilage damage and cartilage repair on MRI. Quantification of hyaline and fibrocartilage biochemical composition is possible with novel MRI methods such as T2- and T1ρ-mapping, delayed gadolinium-enhanced MRI of cartilage, glycosaminoglycan chemical exchange saturation transfer, and sodium imaging, along with quantitative computed tomography arthrography. These techniques provide promising quantitative imaging biomarkers that can detect early cartilage changes before morphological alterations occur.

TFCC Injuries: Meta-Analysis and Comparison of Diagnostic Imaging Modalities.

Background Imaging of the triangular fibrocartilaginous complex (TFCC) remains difficult, as no single imaging modality demonstrates perfect sensitivity and specificity. Purpose This study performs a meta-analysis of multiple previous publications to guide noninvasive imaging selection for the diagnosis of TFCC injuries. Methods A literature search was performed and conducted. Studies were included that compared the diagnostic accuracy of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and computed tomography (CT)/computed tomographic arthrography (CTA) for the evaluation of TFCC injuries. All studies included either arthroscopic or open surgical findings as the "gold standard." A meta-analysis was performed comparing the diagnostic accuracy of MRA, MRI, and CT for the detection of TFCC injuries. Results Initial search returned 2,568 candidate articles. Studies were then reviewed and narrowed yielding a total of 28 independent studies (20 MRI, 9 MRA, 4 CT/CTA with some studies including multiple modalities) considered in the qualitative data synthesis. Pooling of the raw data in a meta-analysis demonstrated sensitivities of 0.76 (0.72-0.80), 0.78(0.70-0.84), and 0.89 (0.81-0.95) for MRI, MRA, and CT arthrogram, respectively, with specificities of 0.82 (0.77-0.86), 0.85 (0.77-0.92), and 0.89 (0.81-0.95), respectively. Additionally, across all imaging modalities, diagnostic accuracy was highest for central TFCC lesions versus peripheral lesions. Conclusion This study represents the largest meta-analysis to date to compare multiple imaging modalities for the diagnosis of TFCC injuries. Pooled data demonstrated that CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. Diagnostic accuracy was highest for central TFCC injuries.

Advanced cartilage imaging for detection of cartilage injuries and osteochondral lesions

Osteochondral defects represent amain risk factor for osteoarthritis of the ankle. The aim of this article is to provide an overview of current optimal clinical cartilage imaging techniques of the foot and ankle and to show typical osteochondral injuries on imaging. A thorough literature search was performed and was supported by personal experience. Cartilage imaging of the foot and ankle remains challenging. However, advanced morphological and quantitative magnetic resonance (MR) imaging techniques may provide useful clinical information, for example, concerning cartilage repair surgery. Compared to MRI, MR arthrography (MR-A) and CT arthrography (CT-A) have higher sensitivity with respect to detection of osteochondral defects. Regarding smaller joints of the foot, mainly advanced osteoarthritic changes are detected on conventional radiography; only in rare cases, MR and CT imaging of these smaller joints is of relevance. While at the smaller joints of the foot cartilage imaging only plays a minor role, at the ankle joint cross-sectional cartilage imaging using CT and MRI becomes more and more important for clinicians due to emerging therapeutic options, such as different osteochondral repair techniques.

Distal radius fractures : Update on imaging

Distal radius fractures are associated with high individual and socioeconomic relevance. Optimized radiography and computed tomography (CT) imaging are essential for individualized therapy planning. Plain CT imaging with 3D reconstruction and digital removal of the carpus and ulna is helpful for choosing the surgical approach in the presence of intra-articular radius fractures. If the fracture line leads towards the scapholunate compartment, ligamentous injury requiring treatment can be detected or ruled out before surgery with the help of direct CT arthrography (CTA). Acquisition of imaging data and morphometrical analysis must be standardized and reproducible. In the diagnostics of distal radius fractures it is necessary for radiologists and surgeons to use aunified fracture classification.

Diagnosing Meniscal Pathology and Understanding How to Evaluate a Postoperative Meniscus Based on the Operative Procedure.

Magnetic resonance imaging (MRI) represents the preferred noninvasive imaging technique to diagnose meniscal pathology in the pre- and postoperative setting. Furthermore, characterization of meniscal tissue MR properties has been possible by the development of advanced MRI techniques. Suspected meniscal tears are a frequent indication for MRI and the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system has been developed to facilitate accurate and uniform reporting of such meniscal tears. Partial meniscectomy and meniscal suture repair are among the commonly performed procedures and several signs have been described to detect postoperative recurrent tears on MRI. Other techniques that have proven useful for meniscal assessment are ultrasound (US) and computed tomography (CT) arthrography. In recent years, US is being increasingly used in the selective assessment of some meniscal pathology such as tears, parameniscal cysts and meniscal extrusion as it is a relatively inexpensive, accessible, and safe technique. CT arthrography has been advocated as an acceptable alternative in patients with contraindications for MRI, with comparable diagnostic performance.

Is Anatomical Healing Essential for Better Clinical Outcome in Type II SLAP Repair? Clinico-Radiological Outcome after Type II SLAP Repair.

BackgroundWe hypothesized that anatomical healing in superior labrum anterior to posterior (SLAP) repair is associated with good clinical outcome. The purposes of this study were to assess the failure rate of anatomical healing after arthroscopic repair of SLAP lesions using computed tomography arthrography (CTA), investigate correlation of the rate with clinical outcomes, and identify prognostic factors for anatomical failure following SLAP repair.MethodsWe retrospectively evaluated the outcome of 43 patients at a minimum follow-up of 1 year after arthroscopic surgery for SLAP lesions or SLAP lesions associated with Bankart lesions. Twenty-eight patients underwent isolated SLAP repair and 15 patients underwent Bankart repair with SLAP repair. The anatomical outcome was assessed using CTA at 1 year after surgery. Clinical outcomes including visual analogue scale for pain and satisfaction and Constant score were assessed at the final follow-up. We investigated clinical failure that was defined as stiffness, loss of maximum rotation, deterioration of pain, and/or need for revision of surgery.ResultsAnatomical failure occurred in 32.6% of patients (14/43), whereas 16.3% of patients (7/43) had clinical failure. Clinicoradiological assessment revealed that clinical failure occurred only in 7.1% of patients (1/14) with unhealed SLAP lesions, whereas it occurred in 20.7% of patients (6/29) with healed SLAP lesions. Isolated SLAP repair resulted in a higher risk of anatomical failure (risk ratio, 7.0) than combined SLAP repair (p = 0.015). Nonoverhead activities were associated with higher risk of anatomical failure (risk ratio, 2.9; p = 0.041). Patients above 35 years of age had more risk of anatomical failure (risk ratio, 3.5; p = 0.010). Clinical outcomes significantly improved regardless of anatomical failure (p < 0.001) and were not significantly different between unhealed and healed repairs (all p > 0.05).ConclusionsSince patients with unhealed SLAP lesions had less clinical failure than patients with healed SLAP lesions, anatomical healing does not seem essential for better clinical outcome of SLAP II repair, especially in patients with higher healing failure risk (isolated SLAP repair, nonoverhead activities, and above 35 years of age). Therefore, we believe the indications of SLAP repair should be narrowed to avoid overtreatment.

The Diagnostic Reproducibility of Tomosynthesis for the Correlation between Acromiohumeral Distance and Rotator Cuff Size or Type.

ObjectiveTo correlate the acromiohumeral distance (AHD) using tomosynthesis and rotator cuff (RC) pathology and various anatomical indices and to assess the diagnostic reproducibility of tomosynthesis for the evaluation of subacromial impingement.Materials and MethodsA retrospective review of 63 patients with clinically suspected subacromial impingement was conducted. Two musculoskeletal radiologists independently measured the following quantitative data: the AHD on plain radiographs and the AHD at three compartments (anterior, middle, and posterior) using tomosynthesis, computed tomography (CT) arthrography, or magnetic resonance (MR) arthrography. To investigate the association between the AHD and RC pathology and various anatomical indices, we reviewed the arthroscopic operation record as the referenced standard.ResultsThe size of rotator cuff tear (RCT) in full-thickness tears displayed a significant inverse correlation with the middle and the posterior tomosynthetic AHDs (p < 0.05). The results of an ANOVA revealed that the middle tomosynthetic AHD retained a significant association with the type of RCT (p = 0.042), and the posterior tomosynthetic AHD retained significance for the size of RCT in a full-thickness tear (p = 0.024). The inter-modality correlation exhibited significant agreement especially among the plain radiography, tomosynthesis, and CT or MR arthrography (p < 0.05). The intraobserver and interobserver correlation coefficients (ICCs) displayed excellent agreement (ICC = 0.896–0.983). The humeral head diameter and glenoid height were significantly correlated with patient height and weight.ConclusionAcromiohumeral distance measurement using tomosynthesis is reproducible compared with other modalities.

Biomechanical Optimization-Based Planning of Periacetabular Osteotomy.

Modern computerized planning tools for periacetabular osteotomy (PAO) use either morphology-based or biomechanics-based methods. The latter rely on estimation of peak contact pressures and contact areas using either patient-specific or constant thickness cartilage models. We performed a finite element analysis investigating the optimal reorientation of the acetabulum in PAO surgery based on simulated joint contact pressures and contact areas using patient-specific cartilage model. Furthermore we investigated the influences of using patient-specific cartilage model or constant thickness cartilage model on the biomechanical simulation results. Ten specimens with hip dysplasia were used in this study. Image data were available from CT arthrography studies. Bone models were reconstructed. Mesh models for the patient-specific cartilage were defined and subsequently loaded under previously reported boundary and loading conditions. Peak contact pressures and contact areas were estimated in the original position. Afterward we used validated preoperative planning software to change the acetabular inclination by an increment of 5° and measured the lateral center-edge angle (LCE) at each reorientation position. The position with the largest contact area and the lowest peak contact pressure was defined as the optimal position. In order to investigate the influence of using patient-specific cartilage model or constant thickness cartilage model on the biomechanical simulation results, the same procedure was repeated with the same bone models but with a cartilage mesh of constant thickness. Comparison of the peak contact pressures and the contact areas between these two different cartilage models showed that good correlation between these two cartilage models for peak contact pressures (r = 0.634 ∈[0.6, 0.8], p < 0.001) and contact areas (r = 0.872 > 0.8, p < 0.001). For both cartilage models, the largest contact areas and the lowest peak pressures were found at the same position. Our study is the first study comparing peak contact pressures and contact areas between patient-specific and constant thickness cartilage models during PAO planning. Good correlation for these two models was detected. Computer-assisted planning with FE modeling using constant thickness cartilage models might be a promising PAO planning tool when a conventional CT is available.

Glenohumeral Ligaments and Unstable Shoulder: CT and MR Arthrography

Glenohumeral Ligaments and Unstable Shoulder: CT and MR Arthrography

SPECT/CT arthrography

Single photon emission CT (SPECT)/CT arthrography, the combination of CT arthrography and late phase bone SPECT/CT, has been developed in 2011 and so far used in knee, ankle and wrist joints. SPECT/CT offers functional information about increased bone turnover in combination with morphological details. Compared with SPECT/CT alone, additional intra-articular contrast enables the assessment of cartilage, menisci, ligaments and loose bodies. SPECT/CT arthrography is a promising alternative technique for the evaluation of internal derangement of joints in patients with MR contraindications and/or metallic implants. In this article, we review and report our 5-year experience with this technique illustrated with patient examples and give a perspective for future applications.

Multidetector CT arthrography in shoulder instability and its comparison with MR arthrography and arthroscopy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Purpose of this study was to compare diagnostic effectiveness of MDCT arthrography (MDCTA) in shoulder instability and pain in throwing and its comparison to MR arthrography (MRA) and arthroscopy taking arthroscopy as gold standard.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 20 patients with history of recurrent shoulder dislocation in activity were included in this study. After detailed clinical examination, each patient underwent MDCT-MR arthrography in one sitting followed by diagnostic arthroscopy within 6 weeks. Results were compared with the help of statistician.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At arthroscopy, 10 Bankart’s lesions, 7 Hill Sachs lesion, 6 SLAP lesion, 1 ALPSA, 1 capsular laxity, 1 partial subscapularis tear and 1 supraspinatus fraying were visualized in 20 shoulders. For Bankart’s lesion MDCT has sensitivity 80%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 83.3%. MRA has sensitivity of 90%, specificity 100%, PPV 100% and NPV 90.9%. For SLAP lesions sensitivity, specificity, PPV and NPV for MDCTA and MRA are 88.3%, 100%, 100%, 93.3%. For Hill-Sachs lesion; sensitivity, specificity, PPV and NPV for MDCTA are all 100% and for MRA they are 85.7%, 100%, 100%, 92.8% respectively. For ALPSA; sensitivity is 100%, specificity is 95%, PPV is 50% and NPV is 100% both for MDCTA and MRA. К value for MRA is 0.60 and for CTA is 0.55 suggesting moderate agreement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Considering availability, cost, time consumption, superior detection of bony lesions and comparable detection of soft tissue lesions; MDCTA can be used as single investigation of choice in shoulder instability pain.&lt;/p&gt;

CT Arthrography Visualizes Joint Regeneration after Microfracture of OLT

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Little is known about arthroscopic or radiographic outcome after arthroscopic microfracture for osteochondral lesions of the talus (OLTs). The purpose of this study was to investigate tissue growth after arthroscopic microfracture for OLT using computed tomography arthrography (CTA) and to correlate this defect filling with clinical outcomes. We hypothesized that the morphology of the repaired tissue would be similar to that of normal anatomy and related to the clinical outcome. Methods: Forty-two ankles treated using arthroscopic microfracture for OLT from 2009 to 2014 were monitored. CTA was performed postoperatively at 6 months, 1, and 2 years. The postoperative thickness of the repaired tissue associated with OLT (grade) and the volume of the subchondral cystic lesions were evaluated using CTA. Clinical outcomes, including a pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle functional score, were evaluated and correlated with CTA. Results: The proportion of fully grown tissue (grade 3) increased over time; specifically, the rates were 12/40 (33.3%) at postoperative 6 months, 11/18 (61.1%) at 1 year, and 8/10 (80%) at 2 years (p=0.005). VAS pain (p&lt;0.001) and AOFAS scores (p&lt;0.001) also improved at the final follow-up; however, they were not associated with repaired tissue thickness on CTA (p=.409 and .579, respectively). Conclusion: Tissue growth after arthroscopic microfracture for OLT was detected in 96% of patients using ankle CTA, with which joint congruency remodeling and subchondral bone formation were well visualized. However, CTA findings were not related to clinical outcomes.

CT arthrography visualizes joint regeneration after microfracture of OLT

Category:Ankle, Arthroscopy, SportsIntroduction/Purpose:Little is known about arthroscopic or radiographic outcome after arthroscopic microfracture for osteochondral lesions of the talus (OLTs). The purpose of this study was to investigate tissue growth after arthroscopic microfracture for OLT using computed tomography arthrography (CTA) and to correlate this defect filling with clinical outcomes. We hypothesized that the morphology of the repaired tissue would be similar to that of normal anatomy and related to the clinical outcome.Methods:Forty-two ankles treated using arthroscopic microfracture for OLT from 2009 to 2014 were monitored. CTA was performed postoperatively at 6 months, 1, and 2 years. The postoperative thickness of the repaired tissue associated with OLT (grade) and the volume of the subchondral cystic lesions were evaluated using CTA. Clinical outcomes, including a pain visual analog scale (VAS) and the American Orthopedic Foot and Ankle Society (AOFAS) ankle functional score, were evalua...

Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data.

The goal of this prospective study was to assess the reliability of pre-operative cross-sectional imaging for the diagnosis of long head of biceps (LHB) tendinopathy in patients with a rotator cuff tear. Cross-sectional imaging with MRI or CT arthrography data from 25 patients operated upon because of a rotator cuff tear between 1 October 2015 and 1 April 2016 was analysed by one experienced orthopaedic surgeon, one experienced radiologist and one orthopaedic resident. The analysis consisted of determining whether the LHB was present, the extrinsic tendon abnormalities (dislocation, tendon coverage) and intrinsic abnormalities (fraying, inflammation, degeneration). These findings were then compared to intra-operative arthroscopy findings, which were used as the benchmark. The interobserver correlation between the three different examiners for the cross-sectional imaging analysis as well as the correlation between the imaging and arthroscopy data were determined. The correlation between the imaging and arthroscopy data was the highest (80%) for the determination of LHB dislocation from the bicipital groove. The other diagnostic elements (subluxation, coverage and tendon degeneration) were difficult to discern with preoperative imaging, and correlated poorly with the arthroscopy findings (45% to 65%). The interobserver correlation was moderate to strong for the diagnosis of extrinsic tendon abnormalities. It was low to moderate for intrinsic abnormalities. Except for LHB dislocation, pre-operative imaging is not sufficient to make a reliable diagnosis of LHB tendinopathy. Arthroscopy remains the gold standard for the management of LHB tendinopathy, as diagnosed intra-operatively.