5/8/2014. I have no relevant disclosures
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1 /8/14 I have no relevant disclosures Robert Lucas MD, Drew Lansdown MD, Sonia Lee MD, Lorenzo Nardo MD, Andrew Lai BS, Roland Krug MD, C.Benjamin Ma MD May 8, 14 Increasing prevalence with the aging population, significant burden on health care system. Colvin. JBJS 12. AAOS. 4 Yamaguchi. AAOS Jan 11 Fucentese. JBJS 12 Durable results years post op. Fucentese. JBJS 12 Functional outcome correlates with repair integrity. Fuchs. JBJS 6 Predictors of failure: Age Tear size Muscle atrophy Fatty infiltration Boileau. JBJS Lafosse. JBJS 7 Adamson. JSES
2 /8/14 Increasing prevalence with the aging population, significant burden on health care system. Colvin. JBJS 12. AAOS. 4 Yamaguchi. AAOS Jan 11 Fucentese. JBJS 12 Durable results years post op. Fucentese. JBJS 12 Functional outcome correlates with repair integrity. Fuchs. JBJS 6 Predictors of failure: Age Tear size Muscle atrophy Fatty infiltration Boileau. JBJS Lafosse. JBJS 7 Adamson. JSES 1993 Correlates with: Size and duration of the tear Goutallier. JSES 3. Higher risk of repair failure Gladstone. AJSM 7. Gerber. JSES 7. Tear size progression Maman. JBJS 9. Worse clinical and radiographic outcomes Maman. JBJS 9. Jost. JBJS. Zingg. JBJS 7. p<. Subjective Qualitative Questionable reliability Moderate intra (K.43) and inter-observer reliabilty (K.6) Slabaugh. AJSM 12. Poor inter-observer agreement (K.1) Spencer. AJSM Quantitative fat measurement Reeder. J Magn Reson. Imag.. Validated in vivo: Lipid extraction Quantitative histologic analysis Chemical analysis Hines. Radiology. Hu. Int J Body Compos Res 11. Previously proven reliable in shoulder Excellent ICC.94 Correlates with Goutallier s Classification Nardo. J Magn Reson Imaging 13 2
3 /8/14 IDEAL MRI fat quantification will provide a continuous objective variable that correlates with rotator cuff tendon pathology. 182 patients underwent MRI scans for shoulder pain Clinical AP Pathology No Tear- Partial thickness tear Full thickness tear No Tear- Partial thickness tear Full thickness tear Full Thickness Cuff Tears 3 Number of patients Number of patients 7 6 MRI scans segmented for regions of interest Fat content quantified with computer program Manually size Tear retraction atrophy (occupation ratio) 7 IDEAL MRI scans Rotator Cuff tendon tear Pathology 8 Number of patients Small Medium Large Massive 3
4 /8/14 Spearman Rho Correlations Clinical Variable Occupation Ratio IDEAL IDEAL IDEAL Fat Fraction vs Rotator Cuff Tear Size 3 Anterior Posterior Rotator Cuff Tear Size Tear Retraction IS IDEAL fat fraction value Age none small medium large massive Chronicity Rotator Cuff Tear Size p<. IDEAL Fat Fraction vs Rotator Cuff Tear Size 3 IDEAL Fat Fraction vs Rotator Cuff Tear Size 3 none small medium large massive none small medium large massive Rotator Cuff Tear Size Rotator Cuff Tear Size p<. p<. 4
5 /8/14 IDEAL Fat Fraction vs Rotator Cuff Tear Retraction 4 3 IDEAL Fat Fraction vs Rotator Cuff Tear Retraction 4 3 none less than 1cm less than humeral head humeral head to none less than 1cm less than humeral humeral head to head Rotator Cuff tear retraction Rotator Cuff tear retraction p<. p<. IDEAL Fat Fraction vs Rotator Cuff Tear Retraction 4 3 IDEAL vs Occupation Ratio 4 3 Suprapinatus none less than 1cm less than humeral head humeral head to Rotator Cuff tear retraction Occupation ratio p<. p<.
6 /8/14 IDEAL MRI provides a continuous objective variable with which to quantify rotator cuff muscular fatty infiltration. IDEAL MRI fat fraction values significantly correlate with the severity of rotator cuff tendon pathology. Longitudinal study Pre and post operative evaluation Natural history of rotator cuff muscle degeneration Guidance in clinical decision making 6
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