Defining massive rotator cuff tears: a Delphi consensus study.
Delphi technique
Massive rotator cuff tear
classification
consensus
definition
rotator cuff tear
shoulder surgery
Journal
Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
27
07
2019
revised:
21
10
2019
accepted:
27
10
2019
entrez:
22
3
2020
pubmed:
22
3
2020
medline:
24
9
2020
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 32197762
pii: S1058-2746(19)30754-2
doi: 10.1016/j.jse.2019.10.024
pmc: PMC7100923
mid: NIHMS1543315
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
674-680Subventions
Organisme : NIAMS NIH HHS
ID : K08 AR072092
Pays : United States
Informations de copyright
Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Références
Arthroscopy. 2018 Jan;34(1):93-99
pubmed: 29146165
J Bone Joint Surg Am. 2001 Jan;83(1):71-7
pubmed: 11205861
J Bone Joint Surg Am. 2010 Aug 4;92(9):1894-908
pubmed: 20686065
J Bone Joint Surg Am. 1991 Aug;73(7):982-9
pubmed: 1874784
J Shoulder Elbow Surg. 2015 Sep;24(9):1493-505
pubmed: 26129871
J Arthroplasty. 2016 Nov;31(11):2380-2384
pubmed: 27562090
Clin Orthop Relat Res. 1994 Jul;(304):43-53
pubmed: 8020233
J Shoulder Elbow Surg. 2010 Apr;19(3):439-45
pubmed: 19734058
J Shoulder Elbow Surg. 2002 Sep-Oct;11(5):498-503
pubmed: 12378171
J Bone Joint Surg Am. 2014 May 7;96(9):e76
pubmed: 24806022
Am J Sports Med. 2018 Nov;46(13):3299-3306
pubmed: 28985094
J Bone Joint Surg Am. 2008 Nov;90(11):2423-31
pubmed: 18978411
Arthroscopy. 2017 Dec;33(12):2281-2283
pubmed: 29032902
J Shoulder Elbow Surg. 2016 Dec;25(12):1907-1917
pubmed: 27496354
Clin Orthop Relat Res. 2017 Dec;475(12):3044-3055
pubmed: 28856514
J Bone Joint Surg Am. 2003 Apr;85(4):690-6
pubmed: 12672846
J Shoulder Elbow Surg. 2017 Sep;26(9):e265-e277
pubmed: 28684233
J Bone Joint Surg Am. 2007 Jun;89(6):1248-57
pubmed: 17545428
Surg Gynecol Obstet. 1982 May;154(5):667-72
pubmed: 7071702
Clin Orthop Relat Res. 1991 Jun;(267):45-56
pubmed: 2044292
Clin Orthop Relat Res. 2010 Jun;468(6):1578-87
pubmed: 19629607
J Bone Joint Surg Am. 2012 May 16;94(10):891-8
pubmed: 22617916
Surg Radiol Anat. 2014 Dec;36(10):993-1000
pubmed: 24985026
J Bone Joint Surg Am. 2004 Feb;86(2):219-24
pubmed: 14960664
J Bone Joint Surg Am. 2007 May;89(5):953-60
pubmed: 17473131
J Shoulder Elbow Surg. 2014 Aug;23(8):1107-12
pubmed: 24439247
Clin Anat. 2014 Apr;27(3):365-9
pubmed: 24038199
J Bone Joint Surg Am. 2000 Apr;82(4):505-15
pubmed: 10761941
Am J Sports Med. 2017 Jan;45(1):157-166
pubmed: 28036238
Musculoskeletal Care. 2014 Jun;12(2):82-91
pubmed: 23949892
J Bone Joint Surg Am. 2013 Apr 3;95(7):627-32
pubmed: 23553298
J Shoulder Elbow Surg. 2017 Jun;26(6):e177-e187
pubmed: 28526423
Arthroscopy. 2013 Aug;29(8):1437-49
pubmed: 23711754
Clin Orthop Relat Res. 1994 Jul;(304):54-9
pubmed: 8020234
Arthroscopy. 2006 Jun;22(6):581-6
pubmed: 16762694