Erickson Brandon J, Chalmers Peter N, Potter Hollis G, Altchek David W, Romeo Anthony A
Shoulder & Elbow/Sports Medicine Division, Rothman Orthopaedic Institute, New York, New York, USA.
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA.
Orthop J Sports Med. 2019 Mar 4;7(3):2325967119826548. doi: 10.1177/2325967119826548. eCollection 2019 Mar.
Recent awareness of latissimus dorsi/teres major (LD/TM) injuries has led to an increase in diagnoses. No magnetic resonance imaging (MRI) classification system specific to the LD/TM exists, nor has tear severity been correlated with ability to return to sport (RTS).
PURPOSE/HYPOTHESIS: The purpose of this study was to report a novel MRI classification system for LD/TM tears as well as to correlate tear grade with performance and RTS. We hypothesized that the new MRI classification system would have high intra- and interobserver reliabilities and that players with higher grade tears would require operative management.
Cohort study (diagnosis); Level of evidence, 3.
All patients with LD/TM tears diagnosed by MRI who were under the care of 2 orthopaedic surgeons were included. On 2 occasions 60 days apart, MRIs were reviewed and graded by 2 authors using a new classification system. Intra- and interobserver reliabilities were calculated. Timing from injury to RTS was recorded, and performance upon RTS was analyzed.
The proposed grading system had excellent intra- and interrater reliabilities (Cohen kappa >0.850). A total of 20 male patients (mean ± SD age, 26 ± 9.3 years) with LD/TM tears were included (80% were baseball pitchers). Of the 16 players treated operatively, 5 were initially treated nonoperatively by an outside physician but could not RTS (all professional baseball pitchers); 2 of these players had grade IIIA tears and 3 of the players had grade IVA tears. Regardless of initial treatment, ultimately 100% of the professional baseball players were able to RTS at a mean of 8.7 ± 3.3 months, although the initial nonoperative management failed for some of these players and they needed surgical intervention. No statistically significant differences were found between pre- versus postoperative performance in those professional players who were treated surgically.
The proposed MRI-based grading system for LD/TM tears had excellent reliability. This system may allow physicians to better advise patients and all involved health care providers. Consideration should be given to acutely treat grade III and IV tears with operative repair.
最近对背阔肌/大圆肌（LD/TM）损伤的认识提高，导致诊断数量增加。目前尚无针对LD/TM的磁共振成像（MRI）分类系统，且撕裂严重程度与恢复运动（RTS）能力之间也未建立关联。
目的/假设：本研究的目的是报告一种用于LD/TM撕裂的新型MRI分类系统，并将撕裂分级与运动表现和RTS相关联。我们假设新的MRI分类系统将具有较高的观察者内和观察者间可靠性，且撕裂分级较高的运动员需要手术治疗。
队列研究（诊断）；证据等级，3级。
纳入所有由2名骨科医生诊治的经MRI诊断为LD/TM撕裂的患者。两名作者在相隔60天的两个时间点使用新的分类系统对MRI进行评估和分级。计算观察者内和观察者间可靠性。记录从损伤到RTS的时间，并分析RTS时的运动表现。
所提出的分级系统具有出色的观察者内和观察者间可靠性（Cohen κ>0.850）。共纳入20例LD/TM撕裂的男性患者（平均年龄±标准差，26±9.3岁）（80%为棒球投手）。在16例接受手术治疗的运动员中，5例最初由外部医生进行非手术治疗但未能RTS（均为职业棒球投手）；其中2例运动员为IIIA级撕裂，3例运动员为IVA级撕裂。无论初始治疗如何，最终100%的职业棒球运动员平均在8.7±3.3个月时能够RTS，尽管其中一些运动员最初的非手术治疗失败且需要手术干预。在接受手术治疗的职业运动员中，术前与术后运动表现之间未发现统计学上的显著差异。
所提出的基于MRI的LD/TM撕裂分级系统具有出色的可靠性。该系统可能使医生能够更好地为患者及所有相关医疗保健提供者提供建议。对于III级和IV级急性撕裂，应考虑进行手术修复治疗。
