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. 2024 Jan;85(1):171-183.
doi: 10.3348/jksr.2023.0050. Epub 2024 Jan 26.

Preoperative Shoulder MRI Findings to Predict Subscapularis Tendon Tear Requiring Surgical Repair

Ji-Hoon Jung, Young-Hoon Jo, Yeo Ju Kim, Seunghun Lee, JeongAh Ryu

Preoperative Shoulder MRI Findings to Predict Subscapularis Tendon Tear Requiring Surgical Repair

Ji-Hoon Jung et al. J Korean Soc Radiol. 2024 Jan.

Abstract
in English, Korean

Purpose: This study aimed to investigate which indirect parameters on preoperative MRI were the principal predictors of subscapularis tendon tears (STTs) requiring surgical repair.

Materials and methods: Preoperative MRI scans of 86 patients were retrospectively reviewed for visual assessment of the STT, pathology of the long head of the biceps tendon (LHBT), posterior decentering (PD) of the humeral head, humeral rotation, fatty degeneration, and subscapularis muscle atrophy. To evaluate atrophy, visual grading using the anatomical line connecting the coracoid tip to the glenoid base, designated as the base-to-tip line (BTL), and thickness measurements were performed in the en-face view.

Results: Arthroscopically, 31 patients (36%) exhibited Lafosse type III or IV STT and underwent surgical repair. LHBT pathology (p = 0.002), PD of the humeral head (p = 0.012), fatty degeneration (p < 0.001), and BTL grade (p = 0.003) significantly correlated with STT. In the multivariate analysis, PD of the humeral head (p = 0.011, odds ratio [OR] = 5.14) and fatty degeneration (p = 0.046, OR = 2.81) were independent predictors of STT.

Conclusion: PD of the humeral head and fatty degeneration of the subscapularis can help to diagnose clinically significant STT. Interpretation of these findings may contribute to the planning of an optimal surgical strategy.

목적: 본 연구의 목적은 수술 전 MRI의 다양한 간접 소견 중 어떤 소견이 외과적 치료가 필요한 견갑하건 파열을 예측하는 데 가장 주요한 것인지 조사하는 것이다.

대상과 방법: 총 86명의 환자를 대상으로 수술 전 MRI 영상을 후향적으로 분석하였다. 견갑하건 파열의 직접평가, 이두박근 장두의 병리, 상완골두의 후방위, 상완골 회전, 견갑하근의 지방변성과 위축을 평가하였다. En-face 보기에서 부리돌기의 끝과 관절오목의 기저를 연결한 base-to-tip line (이하 BTL)을 이용한 육안 등급 및 두께 측정을 통해서 위축을 평가하였다.

결과: 관절경 시술에서 31명(36%)의 환자가 Lafosse type III 또는 IV의 견갑하건 파열을 보여, 재건수술을 받았다. 이두박근 장두의 병리(p = 0.002), 상완골두의 후방위(p = 0.012), 견갑하근의 지방 변성(p < 0.001), BTL 등급(p = 0.003)은 견갑하건 파열과 유의한 상관관계가 있었다. 다변량 분석에서 상완골두의 후방위(p = 0.011, odds ratio [이하 OR] = 5.14)와 견갑하근의 지방변성(p = 0.046, OR = 2.81)은 견갑하건 파열의 독립적인 예측인자였다.

결론: 상완골두의 후방위와 지방변성은 견갑하건 파열 진단에 도움이 될 수 있다. 이러한 결과를 판독하는 것은 최적의 수술 전략을 계획하는 데 기여할 수 있다.

Keywords: Fatty Degeneration; Magnetic Resonance Imaging; Posterior Decentering; Rotator Cuff Tear; Subscapularis.

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Conflict of interest statement

Conflicts of Interest: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Determining the posterior decentering of the humeral head. White dot: center of the humeral head, white line: transverse axis of the scapula. This patient had posterior decentering of the humeral head because the white dot was located more than 2 mm posterior to the white line.
Fig. 2
Fig. 2. Estimating the humeral rotation. Two linear lines were drawn through the center of the circle (white dot): one parallel to the sagittal plane (A) and one through the bicipital groove (B). This patient showed 13.6° of humeral external rotation.
Fig. 3
Fig. 3. En-face view of the T2-weighted oblique sagittal plane.
A. Example of grade I atrophy of subscapularis muscle. The subscapularis muscle and tendon exceed the BTL (white line). B. Example of grade II atrophy shows tendon-only above the BTL. C. Example of grade III atrophy shows no subscapularis structures above the BTL. D. Thickness of the subscapularis muscle is measured within the extended anteroposterior glenoid pole line (a), which is drawn perpendicular to the anatomical line connecting the superior and inferior poles of the glenoid (b). BTL = base-to-tip line, C = coracoid, G = glenoid, S = subscapularis muscle
See this image and copyright information in PMC

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