Preoperative mri̇ and physical examination findings;evaluation of specifity-sensitivity and comparison with intraoperative findings in patients undergoing arthroscopic rotator cuff repair

Thirhty three percent of all orthopedic injuries are associated with rotator cuff pathologies. Shoulder joint pain is the third most common complaint seen after back and knee pain among the musculoskeletal complaints. Every year, 1% of adults going to the hospitals with complaints of new onset shoulder pain. Shoulder joint pathologies negatively affect the quality of life and for this reason, it is aimed that the shoulder joint movements should be complete or close and painless. In our clinic, it was aimed to determine the specificity and sensitivity of the findings encountered in preoperative (preop) magnetic resonance imaging (MRI) in patients operated for rotator cuff pathology and to reveal the relationship between the lesions encountered in MRI with intraoperative (intraop) findings. The information (medical records, patient files, radiological images, surgical images) of the patients who underwent rotator cuff repair between 2015-2019, was scanned and evaluated from the hospital database. In MRIs that were taken preop, the sensitivity of the partial rotator cuff tear, staging the full-thickness rotator cuff tear, and fatty degeneration staging were determined. In addition, the pathologies and physical examination findings encountered in the surgery were determined and a comparative evaluation was made with the lesions detected in MRIs. In our study, a total of 162 patients underwent shoulder arthroscopy. When the preoperative physical examination and MRI findings of these patients were compared, the Jobe test was found to be highly sensitive, while the Drop Arm test (Arm drop test) was found to be low-sensitive. A statistically significant difference was found in the Drop Arm test between partial and full-thickness tear groups (p=0,003). No significant difference was found between the groups in the Jobe and Neer tests. There was a statistically significant difference between groups according to Thomazeau fatty degeneration classification (p <0,001). 40,8% of the full-thickness tear group was determined as "Stage 0" and 42,4% of them as "Stage 1". The majority of the partial tear group (83,8%) was found to be "Stage 0". When preoperative MRI and intraop findings are evaluated, MRI examination is an effective and reliable method for detecting rotator cuff tears. However, it should be kept in mind that its sensitivity is low especially in partial tears. When the location is evaluated by comparing the preop MRI and intraop findings of partial rotator cuff tears, the MRI examination can be misleading. The compliance between partial and full-thickness rotator cuff tears, preop MRI and intraop findings was evaluated according to the value of kappa. Low-moderate correlation in partial rotator cuff tears compared to Ellman classification, moderate correlation was detected in full-thickness rotator cuff tears, considering Patte classification. In conclusion, MRI examination is an effective and reliable method for detecting rotator cuff tears in our study. However, it should be kept in mind that the sensitivity of partial tears is low. Both partial and full-thickness rotator cuff tears may appear in the intraop images at an advanced stage, more unexpectedly with more atrophic and more fatty degeneration. For this reason, the treatment process should be planned by establishing the correct diagnosis of rotator cuff pathologies at an early stage.