Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.
Arthroscopy. 2012 Feb;28(2):154-9. doi: 10.1016/j.arthro.2011.07.016. Epub 2011 Oct 21.
The purpose of this study was to determine the interobserver reliability of 3 commonly used classification systems in describing preoperative magnetic resonance imaging (MRI) studies of patients undergoing surgery for full-thickness rotator cuff tears.
Thirty-one patients who underwent arthroscopic rotator cuff repair and had preoperative MRI studies available were selected over a 2-year period. Three board-certified shoulder surgeons independently reviewed these images. Each was instructed in the published method for determining the Patte score on the T2 coronal images, supraspinatus and infraspinatus atrophy on the T1 sagittal images as described by Warner et al., and the Goutallier score of fatty infiltration of the supraspinatus on the T1 coronal/sagittal images. Statistical analysis was then performed to determine the interobserver agreement using the κ statistic, with the level of significance set a priori at P < .01.
None of the classification systems studied yielded excellent or high interobserver reliability. The strongest agreement was found with the Patte classification assessing tendon retraction in the frontal plane (κ = 0.58). The Goutallier classification, which grades fatty infiltration of the supraspinatus, showed moderate interobserver agreement (κ = 0.53) when dichotomized into none to mild (grades 0, 1, and 2) and moderate to severe (grades 3 and 4). Muscle atrophy of both the supraspinatus and infraspinatus yielded the worst interobserver reliability, with only 28% agreement.
The Goutallier, Patte, and Warner MRI classification systems for describing rotator cuff tears did not have high interobserver reliability among 3 experienced orthopaedic surgeons. Fatty infiltration of the supraspinatus and tendon retraction in the frontal planes showed only moderate reliability and moderate to high reliability, respectively. These findings have potential implications in the evaluation of the literature regarding the preoperative classification of rotator cuff tears and subsequent treatment algorithms.
Level III, diagnostic agreement study with nonconsecutive patients.
本研究旨在确定三种常用于描述接受全层肩袖撕裂手术患者术前磁共振成像（MRI）研究的分类系统的观察者间可靠性。
在 2 年期间，选择了 31 名接受关节镜肩袖修复术且术前 MRI 研究可用的患者。三名经过董事会认证的肩部外科医生独立审查了这些图像。每位医生都按照发表的方法，在 T2 冠状图像上确定 Patte 评分，在 Warner 等人描述的 T1 矢状图像上确定冈上肌和冈下肌萎缩程度，以及 T1 冠状/矢状图像上确定冈上肌脂肪浸润的 Goutallier 评分。然后使用κ统计量进行统计学分析，以确定观察者间的一致性，显著性水平预先设定为 P<.01。
研究的分类系统均未产生优秀或高度的观察者间可靠性。在评估额状面肌腱回缩的 Patte 分类中，一致性最强（κ=0.58）。当将 Goutallier 分类（用于分级冈上肌脂肪浸润）分为无至轻度（等级 0、1 和 2）和中至重度（等级 3 和 4）时，其显示出中度的观察者间一致性（κ=0.53）。冈上肌和冈下肌的肌肉萎缩产生了最差的观察者间可靠性，只有 28%的一致性。
在 3 名经验丰富的骨科外科医生中，描述肩袖撕裂的 Goutallier、Patte 和 Warner MRI 分类系统没有高度的观察者间可靠性。冈上肌的脂肪浸润和额状面的肌腱回缩分别仅具有中度和中度至高度的可靠性。这些发现对评估有关肩袖撕裂术前分类和随后治疗算法的文献具有潜在影响。
III 级，非连续患者的诊断一致性研究。
