Sarıkaya Baran, Bahadır Batuhan, Kaya İbrahim, Oklaz Ethem Burak, Bekin Sarıkaya Pelin Zeynep, Kanatlı Ulunay
Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey.
J Shoulder Elbow Surg. 2023 Jan;32(1):17-23. doi: 10.1016/j.jse.2022.06.009. Epub 2022 Aug 2.
Magnetic resonance imaging (MRI) is a well-known, noninvasive diagnostic method for rotator cuff tendon pathologies that are not very sensitive for subscapularis tendon tears. Subcoracoid effusion (SE) is an easily recognizable radiologic sign on MRI. In this study, we aimed to examine the relationship of SE with rotator cuff tear and to investigate whether SE could be a supportive finding in the diagnosis of subscapularis tear in preoperative MRI. Our hypothesis was that SE was a more specific finding of subscapularis tear than other rotator cuff tears.
The data of patients who underwent shoulder arthroscopy in our clinic between 2017 and 2021 were analyzed retrospectively. Four groups were included in the study: patients with a rotator cuff tear accompanied by a subscapularis tear (group 1, n = 273), patients with isolated subscapularis tear (group 2, n = 57), patients with rotator cuff tear with intact subscapularis tendon (group 3, n = 190), and patients without any rotator cuff pathology (group 4, n = 263). Arthroscopic video records and MRIs of all patients were evaluated retrospectively. Subscapularis tendon tears were classified according to the Lafosse classification.
There was a statistically significant difference between the groups in terms of the presence of SE on MRI (P = .001). The presence of SE in group 1 and group 2 was statistically significantly higher than that in both group 3 and group 4 (P = .001), and there was no significant difference between group 3 and group 4 (P > .05). A significant relationship was found between Lafosse classification and SE (P = .001). When the diagnostic powers of the detection of SSC tear and the presence of SE on MRI for SSC tear were compared, Kappa values were 0.615 (P = .001) and 0.701 (P = .001), and overall diagnostic accuracy rates were 80.3% and 85.5%, respectively.
We conclude that SE is a more specific finding for subscapularis tears than other rotator cuff pathologies. We suggest that SE on MRI should also be considered in patients with a rotator cuff tear in whom a subscapularis tear was not detected in preoperative MRI and that the subscapularis tendon should be carefully evaluated during surgery in cases where the effusion is positive.
磁共振成像（MRI）是一种广为人知的用于诊断肩袖肌腱病变的非侵入性方法，但对肩胛下肌腱撕裂不太敏感。喙突下积液（SE）是MRI上一种易于识别的影像学征象。在本研究中，我们旨在研究SE与肩袖撕裂的关系，并探讨SE是否可作为术前MRI诊断肩胛下肌撕裂的支持性发现。我们的假设是，与其他肩袖撕裂相比，SE是肩胛下肌撕裂更具特异性的表现。
回顾性分析2017年至2021年在我院接受肩关节镜检查的患者数据。研究纳入四组：伴有肩胛下肌撕裂的肩袖撕裂患者（第1组，n = 273）、孤立性肩胛下肌撕裂患者（第2组，n = 57）、肩胛下肌腱完整的肩袖撕裂患者（第3组，n = 190）以及无任何肩袖病变的患者（第4组，n = 263）。对所有患者的关节镜视频记录和MRI进行回顾性评估。肩胛下肌腱撕裂根据Lafosse分类进行分级。
各组在MRI上SE的存在情况存在统计学显著差异（P = 0.001）。第1组和第2组中SE的存在率在统计学上显著高于第3组和第4组（P = 0.001），第3组和第4组之间无显著差异（P > 0.05）。发现Lafosse分类与SE之间存在显著关系（P = 0.001）。比较MRI检测肩胛下肌撕裂和SE存在对肩胛下肌撕裂的诊断效能时，Kappa值分别为0.615（P = 0.001）和0.701（P = 0.001），总体诊断准确率分别为80.3%和85.5%。
我们得出结论，与其他肩袖病变相比，SE是肩胛下肌撕裂更具特异性的表现。我们建议，对于术前MRI未检测到肩胛下肌撕裂的肩袖撕裂患者，也应考虑MRI上的SE表现，并且在积液为阳性的情况下，手术中应仔细评估肩胛下肌腱。
