Adam Schumaier1, David Kovacevic2, Christopher Schmidt3, Andrew Green4, Andrew Rokito5, Charles Jobin2, Ed Yian6, Frances Cuomo7, Jason Koh8, Mohit Gilotra9, Miguel Ramirez10, Matthew Williams11, Robert Burks12, Rodney Stanley13, Samer Hasan14, Scott Paxton4, Syed Hasan9, Wesley Nottage15, William Levine2, Uma Srikumaran16, Brian Grawe17. 1. Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA. Electronic address: schumaam@ucmail.uc.edu. 2. Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA. 3. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 4. Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, RI, USA. 5. Langone Orthopaedic Hospital, New York University Langone Health, New York, NY, USA. 6. Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, CA, USA. 7. Department of Orthopaedic Surgery, Montefiore, New York, NY, USA. 8. Department of Orthopaedic Surgery, Northshore University Health System, Evanston, IL, USA. 9. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. 10. Department of Orthopaedic Surgery, OSF HealthCare, Peoria, IL, USA. 11. Louisiana Orthopaedic Specialists, Lafayette, LA, USA. 12. Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA. 13. OrthoCarolina, Mooreseville, NC, USA. 14. Cincinnati Sports Medicine, Cincinnati, OH, USA. 15. The Sports Clinic Orthopaedic Medical Associates, Laguna Hills, CA, USA. 16. Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. 17. Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA.
Abstract
BACKGROUND: A standard definition for massive rotator cuff tears (MRCTs) has not been identified. The purpose of this study is to use the modified Delphi technique to determine a practical, consensus definition for MRCTs. METHODS: This study is based on responses from 20 experts who participated in 4 rounds of surveys to determine a consensus definition for MRCT. Consensus was achieved when at least 70% of survey responders rated an item at least a 4 on a 5-point scale. A set of core characteristics was drafted based on literature review and then refined to achieve a consensus MRCT definition. RESULTS: The following core characteristics reached consensus in the first round: tear size, number of tendons torn, and degree of medial retraction. Magnetic resonance imaging (MRI) and intraoperative findings reached consensus as the modalities of diagnosis. The second round determined that tear size should be measured as a relative value. An initial definition for MRCT was proposed in the third round: retraction of tendon(s) to the glenoid rim and/or a tear with ≥67% greater tuberosity exposure (65% approval). A modified definition was proposed that specified that degree of retraction should be measured in the coronal or axial plane and that the amount of greater tuberosity exposure should be measured in the sagittal plane (90% approval). CONCLUSIONS: This study determined with 90% agreement that MRCT should be defined as retraction of tendon(s) to the glenoid rim in either the coronal or axial plane and/or a tear with ≥67% of the greater tuberosity exposed measured in the sagittal plane. The measurement can be performed either with MRI or intraoperatively.
BACKGROUND: A standard definition for massive rotator cuff tears (MRCTs) has not been identified. The purpose of this study is to use the modified Delphi technique to determine a practical, consensus definition for MRCTs. METHODS: This study is based on responses from 20 experts who participated in 4 rounds of surveys to determine a consensus definition for MRCT. Consensus was achieved when at least 70% of survey responders rated an item at least a 4 on a 5-point scale. A set of core characteristics was drafted based on literature review and then refined to achieve a consensus MRCT definition. RESULTS: The following core characteristics reached consensus in the first round: tear size, number of tendons torn, and degree of medial retraction. Magnetic resonance imaging (MRI) and intraoperative findings reached consensus as the modalities of diagnosis. The second round determined that tear size should be measured as a relative value. An initial definition for MRCT was proposed in the third round: retraction of tendon(s) to the glenoid rim and/or a tear with ≥67% greater tuberosity exposure (65% approval). A modified definition was proposed that specified that degree of retraction should be measured in the coronal or axial plane and that the amount of greater tuberosity exposure should be measured in the sagittal plane (90% approval). CONCLUSIONS: This study determined with 90% agreement that MRCT should be defined as retraction of tendon(s) to the glenoid rim in either the coronal or axial plane and/or a tear with ≥67% of the greater tuberosity exposed measured in the sagittal plane. The measurement can be performed either with MRI or intraoperatively.
Authors: Jeffrey R Dugas; Deirdre A Campbell; Russell F Warren; Bruce H Robie; Peter J Millett Journal: J Shoulder Elbow Surg Date: 2002 Sep-Oct Impact factor: 3.019
Authors: Patrick J Denard; Paul C Brady; Christopher R Adams; John M Tokish; Stephen S Burkhart Journal: Arthroscopy Date: 2017-11-13 Impact factor: 4.772
Authors: David Kovacevic; Robert J Suriani; Brian M Grawe; Edward H Yian; Mohit N Gilotra; S Ashfaq Hasan; Umasuthan Srikumaran; Samer S Hasan; Frances Cuomo; Robert T Burks; Andrew G Green; Wesley M Nottage; Sai Theja; Hafiz F Kassam; Maarouf A Saad; Miguel A Ramirez; Rodney J Stanley; Matthew D Williams; Vidushan Nadarajah; Alexis C Konja; Jason L Koh; Andrew S Rokito; Charles M Jobin; William N Levine; Christopher C Schmidt Journal: J Shoulder Elbow Surg Date: 2020-08-04 Impact factor: 3.019
Authors: Henk F van der Molen; Steven Visser; Jose Hernán Alfonso; Stefania Curti; Stefano Mattioli; David Rempel; Yves Roquelaure; P Paul F M Kuijer; Sietske J Tamminga Journal: BMC Musculoskelet Disord Date: 2021-02-11 Impact factor: 2.362