I guess I'm the anchor leg to bring this bitch home, huh? Alright, alright. Our disclosure on the website, this all began when we did a study on EMG testing of the manual muscle test for the shoulder with a champagne toast and a champagne pour position to try to isolate the supraspinatus. We got a lot of questions on, well what does that mean, what does that do? It was just a test to try to determine where was the best position to isolate the supraspinatus. MRI is the gold standard as an imaging modality for diagnosis and evaluation of rotator cuff tears. The longer elapsed time between the diagnosis of your full thickness rotator cuff tear and surgical intervention could indeed lead to tear progression. But almost all those studies on tear progression being associated with pain are in previously asymptomatic tears. With a symptomatic rotator cuff tear, does time lead to progression? Thus, what is the useful diagnostic life of an MRI in preoperative planning? That is really unknown still at this time. The purpose of the study was to evaluate the time effect on true rotator cuff tear size from the date of the preoperative MRI to the date of the rotator cuff repair, both in the anterior posterior dimension and the medial lateral dimension. We wanted to characterize the agreement from what we saw interoperatively, and this was again a manual muscle test study on champagne toast, champagne pour to the rotator cuff. But then we realized we had these MRIs. So let's take a look at MRI to what we found interoperatively. So the location of the tear, now these were supraspinatus tears, and we divided it into thirds. The anterior, the central, the posterior were multiple locations. The size and the AP and ML in the area. And then we feel the anterior band of the supraspinatus is very important for function, but is there a way to try to determine if that's intact or not? So the patient selection was again the prospective observational study on manual muscle testing. Preoperative MRI was evaluated. We were blinded to the interoperative results, right, tear size, location, and band, anterior band. And then interoperatively, we had measured the tears with a graduated probe. Now the subjects were grouped by time lapse between the MRI and the surgery. Now that was the patient's choice, not ours, so to speak. So preoperative MRI we evaluated with digital software, the AP and medial lateral dimensions, the tear location of anterior, central, or posterior in the supraspinatus. And could we tell was the anterior band of the supra intact? And here we see interoperatively the size with a graduated probe, the location, and it was the anterior band intact. So we have a lot of data. This is a little busy. Here are the patient demographics, and we kind of stratify them by the time frame of MRI to repair. So zero to one month, one to two, two to three, three to nine, and over nine months. Rotator cuff dimensions for MRI and interop. The AP dimension MRI was 17.3, interop 18.3, the delta, same thing as you look down the road. It's a little busy, and we'll try to get to the heart of the matter here. So the association between time interval and tear size progression was significant, both for the anterior-posterior dimension and the medial-lateral dimension. Linear regression analysis comparing time elapsed showed that. What about percent agreement of MRI versus arthroscopy for location, anterior band, anterior position, central, posterior, and the like? And if you look at zero to six months, we have very consistent agreement across the board, around 75%, but look what happens after six months. Our agreement starts to drop fairly precipitously, and now it's a 50-50 proposition. In conclusion, an orthopedic surgeon can have confidence that the rotator cuff tear size will correlate with MRI findings within a certain timeframe. The elapsed time between your preoperative MRI and your rotator cuff repair is associated with an underestimation by MRI of the true tear size. We've all had that experience where you stick the scope in and go, holy crap, when was this MRI done? You know, and you go back and look. And in the AP dimension especially is where we're seeing that increase. The AP dimension on MRI was smaller compared to the interoperative finding, and in the zero to three, excuse me, in the three to nine months, that underestimation was about 2.5 millimeters, but over nine months, the average was about 4.3 millimeters. The anterior band of the supraspinatus and the location of the tear were more accurately predicted when the MRI was less than six months old. So it seems that there may be this watershed area around six months that your MRI may have outlived its useful life, and you may consider getting a new advanced imaging study. And let's face it. Right now, what is it? It's May. The guy's going to come into your office and he's going to go, no, I don't want my rotator cuff repaired because it's golf season. I'll see you in October. And if his MRI is from February, you may want to consider it. Now obviously you've got to individualize it, but it may be a case-to-case basis. But it certainly is food for thought. Thank you very much. Thank you.

preoperative MRI

rotator cuff tears

tear progression

MRI findings

accurate diagnostic imaging