Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) vs. Global: A comparison of 2 scales developed to assess ultrasound images post rotator cuff repair.

BACKGROUND: Ultrasound is commonly used to assess rotator cuff repair (RCR), but no standardized criterion exists to characterize the tendon. PURPOSE: The aims of this study were to (1) develop content validity for ultrasound specific criteria to grade the postoperative appearance of a tendon after RCR, (2) assess the reliability of the criteria, and (3) assess the feasibility to use these assessments. METHODOLOGY: Following expert consultation and literature review for content validity, 2 scales were created: 1) the Fibrillar matrix, Echogenicity, Contour, Thickness, and Suture (FECTS) scale and 2) the Rotator Cuff Repair-Investigator Global Assessment (RCR-IGA). A prospective cohort study was undertaken on patients who had received a RCR and serial B-mode ultrasound images. Four raters assessed the 64-ultrasound images using the scales created in a blinded fashion using intraclass correlation coefficients. RESULTS: The FECTS scale was a composite score with 5 key parameters and the RCR-IGA scale was a 5-point global score. The intrarater reliability for the FECTS scale was excellent for the most experienced rater (0.92) and fair for the rater with no experience (0.72). The intrarater reliability for the RCR-IGA scale was excellent for 3 of the 4 raters (0.80-0.87) and fair when used by the least experienced rater (0.56). Inter-rater testing for all the FECTS scale parameters had excellent reliability (0.82-0.92) except for Fibrillar matrix (0.73). The average time to complete the FECTS scale per image was 23 seconds and 11 seconds for the RCR-IGA scale. CONCLUSION: The FECTS scale and the RCR-IGA scale are reliable tools to assess the ultrasonic appearance of the repaired rotator cuff tendon. The FECTS scale was more reliable for less experienced assessors. The RCR-IGA scale was easier, more time efficient and reliable for those with experience.

Determinants of Operative Time in Arthroscopic Rotator Cuff Repair.

Arthroscopic rotator cuff repairs have been reported to take between 72 and 113 min to complete. This team has adopted its practice to reduce rotator cuff repair times. We aimed to determine (1) what factors reduced operative time, and (2) whether arthroscopic rotator cuff repairs could be performed in under 5 min. Consecutive rotator cuff repairs were filmed with the intent of capturing a <5-min repair. A retrospective analysis of prospectively collected data of 2232 patients who underwent primary arthroscopic rotator cuff repair by a single surgeon was performed using Spearman's correlations and multiple linear regression. Cohen's f2 values were calculated to quantify effect size. Video footage of a 4-min arthroscopic repair was captured on the 4th case. Backwards stepwise multivariate linear regression found that an undersurface repair technique (f2 = 0.08, p < 0.001), fewer surgical anchors (f2 = 0.06, p < 0.001), more recent case number (f2 = 0.01, p < 0.001), smaller tear size (f2 = 0.01, p < 0.001), increased assistant case number (f2 = 0.01, p < 0.001), female sex (f2 = 0.004, p < 0.001), higher repair quality ranking (f2 = 0.006, p < 0.001) and private hospital (f2 = 0.005, p < 0.001) were independently associated with a faster operative time. Use of the undersurface repair technique, reduced anchor number, smaller tear size, increased surgeon and assistant surgeon case number, performing repairs in a private hospital and female sex independently lowered operative time. A <5-min repair was captured.

Tear Size and Stiffness Are Important Predictors of Retear: An Assessment of Factors Associated with Repair Integrity at 6 Months in 1,526 Rotator Cuff Repairs.

This study aimed to identify whether early postoperative shoulder stiffness is associated with improved healing following rotator cuff repair, and if so, how this factor might interact with other factors known to affect rotator cuff repair integrity. Methods: We conducted a retrospective analysis of prospectively collected data from 1,526 primary arthroscopic rotator cuff repairs. Six-week range of motion was assessed to determine shoulder stiffness, and repair integrity was evaluated at 6 months by ultrasound. Multiple logistic regression analysis was used to identify variables that affected retear, and receiver operating characteristic (ROC) curve analysis was used to evaluate predictive thresholds for retear. Results: Tear-size area was the most accurate predictor of retear (area under the curve [AUC] = 0.77; 95% confidence interval [CI] = 0.72 to 0.81), followed by 6-week passive external rotation (AUC = 0.67; 95% CI = 0.63 to 0.72), 6-week passive forward flexion (AUC = 0.67; 95% CI = 0.62 to 0.72), age (AUC = 0.65; 95% CI = 0.60 to 0.70), tear type (partial-thickness versus full-thickness) (AUC = 0.65; 95% CI = 0.61 to 0.69), and hospital type (public versus private) (AUC = 0.43; 95% CI = 0.37 to 0.49). Patients with smaller tears, reduced 6-week passive external rotation, reduced 6-week passive forward flexion, younger age, partial-thickness tears, and operations performed in a private day surgery or hospital setting were more likely to have an intact rotator cuff repair at 6 months. The AUC of this curve was 0.84 (95% CI = 0.80 to 0.87), which indicates that this combination of factors can accurately predict 84% of retears. Reduced range of motion at 6 weeks was associated with improved repair integrity for patients with tears of >1 to 6 cm2; however, this effect was less pronounced in tears of ≤1 cm2 or >6 cm2. Conclusions: Early postoperative stiffness following arthroscopic single-row, inverted-mattress rotator cuff repair at 6 weeks was associated with an intact repair at 6 months. The protective effects of postoperative stiffness and tear size were additive. The chance of retear in patients with a tear of ≤1 cm2 and external rotation of ≤27° at 6 weeks was 1%, while those with tears of >6 cm2 and external rotation of >27° had a 40% chance. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.