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Post-operative rotator cuff integrity, based on Sugaya’s classification, can reflect abduction muscle strength of the shoulder

  • Shoulder
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Magnetic resonance (MR) imaging is common in structural and qualitative assessment of the rotator cuff post-operatively. Rotator cuff integrity has been thought to be associated with clinical outcome. The purpose of this study was to evaluate the inter-observer reliability of cuff integrity (Sugaya’s classification) and assess the correlation between Sugaya’s classification and the clinical outcome. It was hypothesized that Sugaya’s classification would show good reliability and good correlation with the clinical outcome.

Methods

Post-operative MR images were taken two years post-operatively, following arthroscopic rotator cuff repair. For assessment of inter-rater reliability, all radiographic evaluations for the supraspinatus muscle were done by two orthopaedic surgeons and one radiologist. Rotator cuff integrity was classified into five categories, according to Sugaya’s classification. Fatty infiltration was graded into four categories, based on the Fuchs’ classification grading system. Muscle hypotrophy was graded as four grades, according to the scale proposed by Warner. The clinical outcome was assessed according to the constant scoring system pre-operatively and 2 years post-operatively.

Results

Of the sixty-two consecutive patients with full-thickness rotator cuff tears, fifty-two patients were reviewed in this study. These subjects included twenty-three men and twenty-nine women, with an average age of fifty-seven years. In terms of the inter-rater reliability between orthopaedic surgeons, Sugaya’s classification showed the highest agreement [ICC (2.1) = 0.82] for rotator cuff integrity. The grade of fatty infiltration and muscle atrophy demonstrated good agreement, respectively (0.722 and 0.758). With regard to the inter-rater reliability between orthopaedic surgeon and radiologist, Sugaya’s classification showed good reliability [ICC (2.1) = 0.70]. On the other hand, fatty infiltration and muscle hypotrophy classifications demonstrated fair and moderate agreement [ICC (2.1) = 0.39 and 0.49]. Although no significant correlation was found between overall post-operative constant score and Sugaya’s classification, Sugaya’s classification indicated significant correlation with the muscle strength score.

Conclusions

Sugaya’s classification showed repeatability and good agreement between the orthopaedist and radiologist, who are involved in the patient care for the rotator cuff tear. Common classification of rotator cuff integrity with good reliability will give appropriate information for clinicians to improve the patient care of the rotator cuff tear. This classification also would be helpful to predict the strength of arm abduction in the scapular plane.

Level of evidence

IV.

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Acknowledgements

The authors sincerely appreciate the assistance of Matthew Miller and Calvin Chan from Department of Orthopedic Surgery and Bioengineering, University of Pittsburgh.

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Authors and Affiliations

  1. Centre of Shoulder Surgery, Saint-Gregoire Private Hospital Center, Saint-Grégoire, France

    Masahito Yoshida & Phillipe Collin

  2. Centre of Radiology, Saint-Gregoire Private Hospital Center, Saint-Grégoire, France

    Thierry Josseaume

  3. Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-Cho, Mizuho-Ward, Nagoya, Aichi, 467-8601, Japan

    Masahito Yoshida, Hideyuki Goto & Takanobu Otsuka

  4. Nagoya Sports Clinic, Nagoya, Japan

    Katumasa Sugimoto

  5. Division of Orthopaedics and Trauma Surgery, Latour Hospital, Meyrin, Switzerland

    Alexandre Lädermann

Authors
  1. Masahito Yoshida
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  2. Phillipe Collin
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Corresponding author

Correspondence to Masahito Yoshida.

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Conflict of interest

All of the authors have no conflict of interest.

Funding

No funding sources were received for this study.

Ethical approval

The study and follow-up, respecting the criteria of Declaration of Helsinki, has been approved by Institutional Review Board of Association des Medecins du Canton de Geneve et Societe Medicale - La Tour Hospital. The IRB number was 12-26. Nov/2012.

Informed consent

All patients accepted the proposed treatment and follow-up after an adequate information and written consent.

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Yoshida, M., Collin, P., Josseaume, T. et al. Post-operative rotator cuff integrity, based on Sugaya’s classification, can reflect abduction muscle strength of the shoulder. Knee Surg Sports Traumatol Arthrosc 26, 161–168 (2018). https://doi.org/10.1007/s00167-017-4608-5

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