Reproducibility and reliability of subscapularis tendon assessment using CT-arthrography

Area of Science:

• Orthopedic Surgery
• Radiology
• Diagnostic Imaging

Background:

• Computed tomography (CT) arthrography is the standard for preoperative rotator cuff tear evaluation.
• Assessing the subscapularis tendon preoperatively is crucial for surgical planning.

Purpose of the Study:

• To evaluate the intra-observer and inter-observer reproducibility of CT-arthrographic assessment of the subscapularis tendon.
• To determine the validity and reliability of CT-arthrography for subscapularis tendon tears.

Main Methods:

• Retrospective review of 67 shoulders with rotator cuff tears.
• Three readers evaluated preoperative CT-arthrograms twice.
• Statistical analysis using Fleiss' method and concordance coefficients with arthroscopy.

Main Results:

• CT-arthrography demonstrated satisfactory specificity but low sensitivity for the subscapularis tendon.
• Significant inter-observer and intra-observer variabilities were found.
• Major differences between CT-arthrography and arthroscopy were common, indicating poor concordance.

Conclusions:

• CT-arthrography shows significant variability and suboptimal reliability in assessing subscapularis tendon continuity.
• The technique may not provide a valid and reproducible assessment.
• Magnetic resonance (MR) imaging and MR-arthrography are expected to improve preoperative evaluation of subscapularis tears.