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This research investigated the sustainability of textile garments with integrated electronics and their potential impact on the environment. The electronic textiles (E-textiles) sector is booming, with many advancements in E-textile product designs and construction methods having been made in recent years. Although there is a rapidly increasing interest in the reusability and sustainability of textiles, work towards E-textile sustainability requires further attention. Vastly different components are combined when constructing an electronic textile product, which makes it challenging at the end of the life of these products to dispose of them in a responsible way. In this study, a teardown analysis was conducted using a structured method, which first mapped out the interactions between each component of the product with the environment, followed by using Kuusk's sustainable framework to analyze sustainable strategies. The research provides a unique contribution to transitioning sustainability theories into practical applications in the area of E-textiles, and the method proposed in this work can be employed in modifying electronics-embedded textiles to improve longevity and reduce the negative environmental impact. The work has highlighted key points of improvement that could be applied to a series of commercial E-textile garments, as well as a prototype E-textile device. Beyond this, the work provides a systematic approach for implementing new E-textile product designs that can evaluate overall product sustainability from the design stage to material selection, construction, and the planning of the commercial approaches of a product.

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PURPOSE: The purpose of this study was to propose a modified Patte classification system for tendon retraction, including the cut-off points for predicting reparability and rotator cuff healing after arthroscopic rotator cuff repair (ARCR) and assess its prediction accuracy and measurement reliability. METHODS: This retrospective study included 463 consecutive patients scheduled to undergo ARCR for full-thickness supraspinatus tears. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off points for predicting reparability and tendon healing. The modified Patte classification system, in which these cut-off points were combined with the original Patte classification, classified the tendon retraction as stages I-V. The prediction accuracy of reparability and tendon healing was assessed using the area under the curve (AUC). Measurement reliability was determined using Cohen's κ statistics. RESULTS: Of the 402 included patients, 32 rotator cuff tears were irreparable and 71 of the remaining 370 were diagnosed with healing failure. ROC analysis determined the cut-off point of reparability at the medial one-fifth and that of tendon healing at the medial one-third of the humeral head. The AUC of the modified Patte classification for predicting reparability and tendon healing was 0.897 (excellent) and 0.768 (acceptable), respectively. Intra-rater reliability was almost perfect (mean κ value: 0.875), and inter-rater reliability was substantial (0.797). CONCLUSION: Diagnostic performance of the modified Patte classification system was excellent for reparability and acceptable for rotator cuff healing, with high measurement reliability. The modified Patte classification system can be easily implemented in clinical practice for planning surgical procedures and counselling patients in the day-by-day clinical work. LEVEL OF EVIDENCE: Level III.

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Population expansion and improving living standards, particularly in developed nations, have led to an increase in the usage of domestic electrical equipment, worldwide energy consumption, and CO2 emissions per capita. To limit the usage of non-reusable components and the amount of garbage that must be transferred at the end of a product's life cycle, longer-lasting electrical domestic appliances are a pillar of the circular economy. In recent years, the complexity of printed circuit boards (PCBs) used in the manufacture of modern electrical devices has increased, leading to an increase in device failures. This study focuses on the maintenance and recycling of domestic electrical appliance components and printed circuit boards. The proposed methodology for PCB repair is defined as a sequential quadratic programming (SQP) problem implemented in MATLAB environment and successfully tested to a variety of domestic appliances such as refrigerator, dishwasher and washing machine. The possibility of recycling metal parts of electronic components, which were replaced after PCBs' repair was also studied. Metals' percentage concentration of PCB electronic components for three customer's budgets considering metals and valuable metals recovery as given from the corresponding average metal recovery and calculated from different recycling procedures presented in the literature. The results of the proposed procedure in terms of valuable metals gave 38.4078 ppm of silver. We also compared the suggested procedure with other works in terms of environmental perspective considering four measures, namely the gross energy requirement (GER), the global warming potential (GWP), the acidification potential (AP), and the solid waste burden (SWB). In terms of economic perspective and considering the existence of silver (Ag) in the electronic components, the recommended method gave comparable amount of money. Finally, a comparison of different recycling works from a technical viewpoint is also conducted. Moreover, a reparability index of domestic electrical appliances is introduced to further quantify the results of the proposed algorithm.

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BACKGROUND: Flexible flatfoot (FFF) is a very common condition in children, but no evidence-based guidelines or assessment tools exist. Yet, surgical indication is left to the surgeon's experience and preferences. AIM: To develop a functional clinical score for FFF [Catania flatfoot (CTF) score] and a measure of internal consistency; to evaluate inter-observer and intra-observer reliability of the CTF Score; to provide a strong tool for proper FFF surgical indication. METHODS: CTF is a medically compiled score of four main domains for a total of twelve items: Patient features, Pain, Clinical Parameters, and Functionality. Each item refers to a specific rate. Five experienced observers answered 10 case reports according to the CTF. To assess inter- and intra-observer reliability of the CTF score, the intra-class correlation coefficients' (ICCs) statistics test was performed, as well as to gauge the correlation between the CTF score and the surgical or conservative treatment indication. Values of 75% were chosen as the score cut-off for surgical indication. Sensitivity, specificity, positive likelihood ratio (PLHR), negative likelihood ratio (NLHR), positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Overall interobserver reliability ICC was 0.87 [95% confidence interval (CI): 0.846-0.892; P < 0.001]. Overall intra-observer reliability ICC was 0.883 (95%CI: 0.854-0.909; P < 0.001). A direct correlation between the CTF score and surgical treatment indication [Pearson correlation coefficient = 0.94 (P < 0.001)] was found. According to the 75% cut-off, the sensitivity was 100% (95%CI: 83.43%-100%), specificity was 85.71% (95%CI: 75.29%-92.93%), PLHR was 7 (95%CI: 3.94-12.43), NLHR was 0 (95%CI: 0-0), PPV was 75% (95%CI: 62.83%-84.19%) and NPV was 100% (95%CI: 100%-100%). CONCLUSION: CTF represents a useful tool for orthopedic surgeons in the FFF evaluation. The CTF score is a quality questionnaire to reproduce suitable clinical research, survey studies, and clinical practice. Moreover, the 75% cut-off is an important threshold for surgical indication and helps in the decision-making process.

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Background: The use of ultrasound as a viable diagnostic tool for routine office visit evaluation of rotator cuff integrity is slowly gaining acceptance in orthopedic practice. However, the reliability of accurately assessing rotator cuff tear reparability by ultrasound has limited evidence in the literature. The purpose of this study was to compare preoperative assessment of cuff tear reparability via ultrasound with the arthroscopic determination of reparability at the time of surgery. Methods: We prospectively collected preoperative ultrasound and arthroscopic imaging data on 145 patients (80 or 55% men and average age of 60.7 years) who underwent arthroscopic posterior superior rotator cuff repair. Three independent experienced orthopedic surgeons retrospectively reviewed all ultrasound studies and arthroscopic imaging and determined if the posterior superior rotator cuff tendon edge was able to be viewed via ultrasound and determined with the arthroscopic images if the tear was reparable. Results: On review of the ultrasound and arthroscopic data, if the edge of the rotator cuff tendon was able to be viewed on the coronal ultrasound image, it was most likely reparable with a positive predictive value of 97.6% and a positive likelihood ratio of 5.8. Sensitivity was 84.4%, and specificity was 76.9%. The negative predictive value was 37.5%, and the negative likelihood ratio was 0.17. The interobserver reliability was 0.63, and the observers were unanimous in determining the tendon edge was able to be visualized in 99 of 145 cases (68%). Conclusion: Preoperative ultrasound evaluation of the shoulder for posterior superior rotator cuff tears is a useful tool for assessing rotator cuff integrity and may help predict intraoperative reparability of the tendon. This study demonstrates that if the cuff tear edge is able to be visualized, there is a high probability of successful arthroscopic restoration of the tendon to its native attachment. Conversely, if the tear edge is unable to be visualized, there is a moderate chance of the tear being irreparable. These results help expand the knowledge base of the usefulness of in-office ultrasound performed by the surgeon in predicting the results of surgical intervention for rotator cuff tears.

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BACKGROUND: The reparability of large or massive rotator cuff tears is difficult to determine pre-operatively. We previously identified age ≥ 65 years, acromiohumeral interval ≤ 6 mm, and anteroposterior tear size ≥ 22 mm as risk factors for rotator cuff repair failure. We therefore developed a rotator cuff reparability score where each of the above risk factors is assigned a score of one point. AIM: To determine the accuracy of a rotator cuff reparability score. METHODS: This was a retrospective cohort study of recruited patients with large or massive rotator cuff tears treated at our institution between January 2013 and December 2019. Exclusion criteria were revision surgery and patients with contraindications for surgery. All patients underwent arthroscopic rotator cuff repair and were categorized into either complete or partial rotator cuff repair. Rotator cuff reparability scores were calculated for each patient. The sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio were assessed. A receiver operating characteristic curve was plotted to determine the optimal cut-off rotator cuff reparability score. RESULTS: Eighty patients (mean age, 61 years; range, 25-84 years; 41 females and 39 males) were recruited. Intra- and inter-observer reliabilities were good to excellent. The number of patients with 0, 1, 2, and 3 risk factors for rotator cuff repair failure were 24, 33, 17, and 6, respectively. Complete repair was performed in all patients without risk factors. Two of the 33 patients with one risk factor and seven of the 17 patients with two risk factors underwent partial repair. One of the six patients with three risk factors underwent complete repair. The area under the curve was 0.894. The optimal cut-off score was two points with a sensitivity of 85.71% and a specificity of 83.33%. CONCLUSION: A rotator cuff reparability score of two was determined to be the optimal cut-off score for predicting the reparability of large or massive rotator cuff tears.

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PURPOSE: The purpose of this study is to describe rotator cuff muscle stiffness in patients with different degrees of rotator cuff tear (RCT) severity and to assess its predictive ability for RCT reparability. METHODS: One hundred and thirty-three consecutive patients who were scheduled to undergo arthroscopic shoulder surgery were prospectively enrolled. Tendon retraction, fatty infiltration, and muscle atrophy were evaluated using magnetic resonance imaging. Shear modulus of supraspinatus (SSP) and infraspinatus (ISP) muscles were measured by ultrasound shear wave elastography (SWE). The tear size and reparability were determined intraoperatively. RESULTS: There were 97 patients in RCT group and 36 patients in control group. Bilateral shear modulus discrepancy (Δshear modulus) was used to represent rotator cuff stiffness. Severely fatty-infiltrated rotator cuff muscles possessed a significantly higher stiffness compared with their counterparts (SSP: CI 27.8-31.8 vs. 13.5-15.6 kPa, ISP: CI 33.2-38.1 vs. 8.8-11.2 kPa, p < 0.001). The same trend applied to muscles with distinct tendon retraction (SSP: CI 27.7-32.3 vs. 10.9-14.9 kPa, ISP: CI 33.2-38.6 vs. 6.5-11.0 kPa, p < 0.001) and obvious muscle atrophy (SSP: CI 27.9-32.1 vs. 13.6-15.8 kPa, ISP: CI 32.9-38.2 vs. 9.0-11.7 kPa, p < 0.001). Irreparable massive RCT (MRCT) patients had significantly stiffer SSP (CI 27.7-31.9 vs. 13.5-16.5 kPa, p < 0.001) and ISP (CI 33.5-37.8 vs. 10.3-14.8 kPa, p < 0.001) than reparable MRCT. The Δshear modulus of the ISP was a highly accurate predictor of RCT reparability. A cutoff value of 18.0 kPa had a sensitivity of 100% and specificity of 98.8% for irreparable MRCT. CONCLUSION: Ultrasound SWE-derived rotator cuff muscle stiffness is closely correlated with RCT size and severity. LEVEL OF EVIDENCE: I.

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PURPOSE: This study aimed to compare the ability of B-mode ultrasonography and magnetic resonance imaging (MRI) to predict the repairability of large-to-massive rotator cuff tears (RCTs). METHODS: This cross-sectional study included participants with large-to-massive RCTs who underwent arthroscopic repair. B-mode ultrasonography and MRI were conducted prior to arthroscopic repair. B-mode ultrasonography was used to evaluate the echogenicity of the rotator cuff muscle using the Heckmatt scale. Intra-rater and inter-rater reliabilities were examined for two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, two experienced orthopedic surgeons performed surgery and decided whether the torn stump could be completely repaired intraoperatively. RESULTS: Fifty participants were included, and 32 complete repairs and 18 partial repairs were performed. B-mode ultrasonography showed good intra-rater reliability and inter-rater reliability for assessment of the muscle echogenicity of the supraspinatus and infraspinatus muscles. The correlation coefficients between B-mode ultrasound findings and MRI findings showed medium to large effect sizes (r=0.4-0.8). The Goutallier classification of the infraspinatus muscles was the MRI predictor with the best discriminative power for surgical reparability (area under the curve [AUC], 0.89; 95% confidence interval [CI], 0.81 to 0.98), while the Heckmatt scale for infraspinatus muscles was the most accurate ultrasound predictor (AUC, 0.85; 95% CI, 0.74 to 0.96). No significant differences in AUCs among the MRI and ultrasound predictors were found. CONCLUSION: B-mode ultrasonography was a reliable examination tool and had a similar ability to predict surgical reparability to that of MRI among patients with large-to-massive RCTs.

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BACKGROUND: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. PURPOSE: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into "complete repair" and "partial repair" groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. RESULTS: The average rotator cuff tear size was 28 × 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969; P = .001), fatty infiltration of the infraspinatus of grade ≤2 (OR, 3.537; P = .001), coronal tear size ≥26 mm (OR, 3.315; P = .002), and remnant tendon length <15 mm (OR, 2.584; P = .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). CONCLUSION: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of ≥3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis.

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PURPOSE: To investigate the reparability of aged and fresh resin composite after different mechanical surface pretreatments. MATERIALS AND METHODS: Sixty composite specimens (Filtek Supreme XTE, 3M Oral Care) were either aged by thermal cycling (5000 cycles, 5-55°C) and six months of water storage, or immediately processed within 5 min after polymerization. Both aged and fresh specimens were either ground with fine (46-µm) or coarse (100-µm) diamond burs and then silanized or sandblasted with aluminum oxide (Al2O3) and silanized. In the negative control group, no mechanical surface pretreatment or silanization was performed. Specimens (n = 6 per group) were repaired with an adhesive (OptiBond FL, Kerr) and a resin composite (Filtek Supreme XTE). Directly adhered composite-to-composite increments served as the positive control group. After thermoycling, microtensile repair bond strength was assessed and statistically analyzed (α = 0.05). RESULTS: Aged composite surfaces revealed significantly lower repair bond strength than immediately repaired composite. The negative control group demonstrated the significantly lowest microtensile bond strength of all groups. No significant differences in repair bond strength were observed between the different mechanical pretreatments for both aged and fresh specimens. The repair bond strength of fresh composite pretreated with a fine diamond bur + Al2O3 + silane or a coarse diamond bur with/without Al2O3 + silane did not differ significantly from the positive control group. CONCLUSION: The age of the repaired composite has a greater influence on repair bond strength than does the type of composite surface pretreatment.

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BACKGROUND: As the indications for reverse total shoulder arthroplasty (RTSA) have continued to expand, the average age of patients undergoing RTSA has decreased. PURPOSE/HYPOTHESIS: The purpose of this study was to report the minimum 2-year outcomes after RTSA and to evaluate the impact of surgical variables on outcomes. We hypothesized that younger patients, patients with larger glenosphere, and patients with irreparable subscapularis tendons would experience worse subjective patient-reported outcome scores (PROS) and that younger patients and those with a reparable subscapularis would demonstrate a higher rate of return to recreational sports activities. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients who underwent RTSA by a single surgeon between November 2005 and September 2014 were considered for this study. Patient characteristics, surgical details, PROS, and rates of return to recreational sports activity were prospectively collected and retrospectively reviewed. We assessed correlations between PROS and both patient age and subscapularis reparability. PROS collected included the American Shoulder and Elbow Surgeons (ASES) score, Short Form 12 (SF-12), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Single Assessment Numeric Evaluation (SANE), and postoperative patient satisfaction. RESULTS: A total of 110 patients with an average age of 68.0 years (range, 45-87 years) were included. Minimum 2-year follow-up was obtained in 94 patients (85.4%), with a mean follow-up of 3.6 years (range, 2.0-9.3 years). The subscapularis was reparable in 58 patients (57.4%). All PROS significantly improved from pre- to postoperatively (P < .001). The median patient postoperative satisfaction was 9 out of 10 (range, 1-10). Increasing patient age was correlated with significant improvements in QuickDASH and ASES scores. Postoperatively, 76.1% (67/88) of patients were able to return to recreational sports activity. However, of those who did return, 68.2% indicated that they had to modify their activity in some way. Glenosphere size was not significantly associated with PROS or the rate of return to recreational sports activity, but patients with reparable subscapularis tendons demonstrated higher PROS and return to activity rates. CONCLUSION: Patients who had a reparable subscapularis tendon showed a significantly higher rate of return to recreational sports activity than patients who had a irreparable subscapularis tendon. Older age was correlated with greater improvement in several, although not all, patient-reported outcome measures. Glenosphere size was not significantly associated with higher PROS or rate of return to recreational sports activity.

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BACKGROUND: The purpose of this study is to determine the pre-operative factors that are associated with reparability of the large-sized and massive rotator cuff tears. METHODS: Sixty-six patients were included in this prognostic study. Demographic data, radiographic and MRI parameters were collected. Arthroscopic rotator cuff repair was performed for all included patient. Complete rotator cuff repair was achieved when the tendon covered up at least 50% of the anatomical footprint. The receiver operating characteristic (ROC) curve was analysed to define the cut-off level of each significant factor. RESULTS: Eleven large-sized rotator cuff tears and fifty-five massive rotator cuff tears were defined from MRI. Fifty-four patients were in the complete repair group, and twelve patients were in the partial repair group. The mean duration between MRI and surgery of 5.5 weeks. Reparability was correlated with age, mediolateral (ML) and anteroposterior (AP) tear size, rotator cuff arthropathy, superior migration of humeral head, fatty infiltration and atrophy of the supraspinatus muscle, and fatty infiltration of infraspinatus muscle (p < 0.05). The ROC curve defined a cut-off level of each predicting factor which included age of ≥65 years, mediolateral tear size of ≥36 mm, anteroposterior tear size of ≥22 mm, Hamada's rotator cuff arthropathy of ≥class2, acromiohumeral interval of ≥6 mm, ≥stage3 supraspinatus fatty infiltration, the presence of supraspinatus muscle atrophy, and ≥ stage1 infraspinatus fatty infiltration. In multivariated regression analysis, age, acromiohumeral interval, and anteroposterior tear size were statistically associated with the reparability. The intra- and inter-observer reliabilities were moderate to excellent. CONCLUSION: Age, ML tear size, AP tear size, rotator cuff arthropathy, superior migration of humeral head, fatty infiltration of supraspinatus and infraspinatus muscles and supraspinatus muscle atrophy all correlate with reparability of large to massive rotator cuff tear.

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PURPOSE: The purpose of this study was to evaluate the role of surgeons' experience with meniscal repairs and meniscectomy decisions, and to determine the factors affecting the disagreement between meniscal repairs and meniscectomy decisions. METHODS: In total, 223 patients with meniscal tears, 106 meniscal repairs, and 117 meniscectomies were included. Six orthopedic surgeons (3: > 5 years; 3: < 5 years' arthroscopy experience) were blinded, and they independently reviewed all preoperative MR images for over a month. Their reviews were compared with arthroscopic interventions performed by a surgeon with > 10 years' arthroscopy experience. Reparability-associated factors were also evaluated using multivariate logistic regression. RESULTS: The first and second evaluation results did not differ significantly between groups (n.s.). There was good agreement between MRI predictions and arthroscopic interventions for both groups (< 5 years' experience: k = 0.248, agreement 62.3%; > 5 years' experience: k = 0.351, agreement 67.3%). Sex, side, and distance of tear from the meniscocapsular junction were not significantly different between agreements and disagreements. Disagreement regarding meniscectomy was significantly higher than those regarding meniscus repair (p = 0.002). Concomitant anterior cruciate ligament (ACL) injury, osteochondral lesions, and medial meniscal tear increased the likelihood of meniscal repair (p = 0.0063, p = 0.0010, and p = 0.0369, respectively). An increased risk of disagreement between MRI and surgical procedure was found in the presence of bucket-handle, horizontal or complex tear, chronic tear, high sports activity and expectation level. CONCLUSION: Surgeon's experience level may influence the prediction of meniscus reparability. Concomitant ACL injury, osteochondral lesions, and presence of medial meniscal tear increase the likelihood of meniscal repair. Tear type, tear chronicity, patient's activity and expectation level may influence the surgeon's operative decision in addition to MRI. LEVEL OF EVIDENCE: III.

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BACKGROUND: Numerous studies have shown preoperative fatty infiltration of rotator cuff muscles to be strongly negatively correlated with the successful repair of massive rotator cuff tears (RCTs). PURPOSE: To assess the association between factors identified on preoperative magnetic resonance imaging (MRI), especially infraspinatus fatty infiltration, and the reparability of massive RCTs. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We analyzed a total of 105 patients with massive RCTs for whom MRI was performed ≤6 months before arthroscopic procedures. The mean age of the patients was 62.7 years (range, 46-83 years), and 46 were men. Among them, complete repair was possible in 50 patients (48%) and not possible in 55 patients (52%). The tangent sign, fatty infiltration of the rotator cuff, and Patte classification were evaluated as predictors of reparability. Using the receiver operating characteristic curve and the area under the curve (AUC), the prediction accuracy of each variable and combinations of variables were measured. RESULTS: Reparability was associated with fatty infiltration of the supraspinatus ( P = .0045) and infraspinatus ( P < .001) muscles, the tangent sign ( P = .0033), and the Patte classification ( P < .001) but not with fatty infiltration of the subscapularis and teres minor ( P = .425 and .132, respectively). The cut-off values for supraspinatus and infraspinatus fatty infiltration were grade >3 and grade >2, respectively. The examination of single variables revealed that infraspinatus fatty infiltration showed the highest AUC value (0.812; sensitivity: 0.86; specificity: 0.76), while the tangent sign showed the lowest AUC value (0.626; sensitivity: 0.38; specificity: 0.87). Among 2-variable combinations, the combination of infraspinatus fatty infiltration and the Patte classification showed the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96). The combination of 4 variables, that is, infraspinatus and supraspinatus fatty infiltration, the tangent sign, and the Patte classification, had an AUC of 0.866 (sensitivity: 0.28; specificity: 0.98), which was lower than the highest AUC value (0.874; sensitivity: 0.54; specificity: 0.96) among the 2-variable combinations. CONCLUSION: The tangent sign or Patte classification alone was not a predictive indicator of the reparability of massive RCTs. Among single variables, infraspinatus fatty infiltration was the most effective in predicting reparability, while the combination of Goutallier classification <3 of the infraspinatus and Patte classification ≤2 of the rotator cuff muscles was the most predictive among the combinations of variables. This information may help predict the reparability of massive RCTs.

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BACKGROUND: We wished to determine the correlation between supraspinatus muscle occupation ratio and reparability of rotator cuff muscles and that of each occupation ratio with 1-muscle, 2-muscle, and 3-muscle rotator cuff injury. METHODS: We evaluated 170 patients (average age, 62.3 [40-83] years) with complete (type II) or incomplete (type III) rotator cuff repair by arthroscopy. Type II repair was defined as complete repair but less optimal coverage of the entire medial-lateral footprint. Type III repair was defined as incomplete repair; a small portion (<10 mm) of the humeral head is exposed. Patients were divided into 2 groups: 96 and 74 patients who underwent type II and type III repair, respectively. Patients were also categorized into 4 groups: isolated supraspinatus tears, supraspinatus and infraspinatus tears, supraspinatus and subscapularis tears, and tears in all 3 muscles. Supraspinatus muscle atrophy was evaluated by the occupation ratio on the most lateral T1-weighted sagittal oblique view in which the scapular spine contacted the scapular body. The supraspinatus muscle occupation ratio was measured by 2 independent observers. RESULTS: On magnetic resonance imaging, the supraspinatus muscle occupation ratio was significantly different between the completely repaired and incompletely repaired groups. The mean occupation ratio of the completely repaired group (42.39 ± 10.1) was significantly higher than that of the incompletely repaired group (36.64 ± 6.94). The cutoff value of the supraspinatus muscle occupation ratio (complete to incomplete repair) was 41. The supraspinatus muscle occupation ratio significantly decreased as the tear increased (P < .001). CONCLUSION: A supraspinatus muscle occupation ratio of <41 can be the cutoff value for greater tuberosity coverage vs. incomplete coverage. There was a significant correlation between tear pattern and supraspinatus muscle atrophy ratio. The supraspinatus tear group had the lowest degree of muscle atrophy.

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BACKGROUND: The primary purpose of this study was to explore the relationship between patient satisfaction and rotator cuff tendon reparability. MATERIALS AND METHODS: This was a secondary analysis of prospectively collected data of consecutive patients who underwent arthroscopic repair of full-thickness rotator cuff tear and were followed up for 2 years. The satisfaction level was rated on a 6-point Likert scale. Patient-oriented disability measures included the American Shoulder and Elbow Surgeons score, the short version of the Western Ontario Rotator Cuff index, the Constant-Murley score, and the Quick Disabilities of the Arm, Shoulder, and Hand. Partial repair was defined as repair with >1 cm residual gap. RESULTS: There were 145 patients (65 women, 80 men; mean age, 62 years) who met the inclusion criteria. There were 12 massive, 31 large, and 102 small or moderate rotator cuff tears. Of 43 large or massive tears, 23 had a partial repair. There was a statistically significant relationship between satisfaction and tendon reparability (P = .01). Patients with work-related shoulder injury reported less satisfaction with surgery (P = .005). Age, gender, or tear size did not affect satisfaction with surgery. Satisfaction was a predictor of all postoperative outcome scores after being adjusted for preoperative scores (P = .001 to P < .0001). CONCLUSION: In this study, patients with partial repair and those with an active compensable injury were less satisfied with surgery than their counterparts were. Older age, female sex, or a larger tear was not a negative predictor of patient satisfaction.

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AIMS: The aim of the study was to develop a quantitative scoring system to predict whether a large-to-massive rotator cuff tear was arthroscopically reparable prior to surgery. PATIENTS AND METHODS: We conducted a retrospective review of the pre-operative MR imaging and surgical records of 87 patients (87 shoulders) who underwent arthroscopic repair of a large-to-massive rotator cuff tear. Patients were divided into two groups, based on the surgical outcome of the repair. Of the 87 patients, 53 underwent complete repair (Group I) and 34 an incomplete repair (Group II). Pre-operative MR images were reviewed to quantify several variables. Between-group differences were evaluated and multiple logistic regression analysis was used to calculate the predictive value of significant variables. The reparability index (RI) was constructed using the odds ratios of significant variables and a receiver operating characteristic curve analysis performed to identify the optimal RI cutoff to differentiate between the two groups. RESULTS: The following variables were identified as independent predictors of arthroscopic reparability: the size of the defect with medial-lateral diameter (cutoff, 4.2 cm) and anterior-posterior diameter (cutoff, 3.7cm); Patte's grade of muscle atrophy (cutoff, grade 3) and Goutallier grade of fatty degeneration (cutoff, grade 3). An RI cutoff value of 2.5 provided the highest differentiation between groups I and II, with an area under the curve of 0.964, and a sensitivity of 73.5% and specificity of 96.2%. CONCLUSION: The RI developed in our study may prove to be an efficient clinical scoring system to predict whether a large-to-massive rotator cuff tear is arthroscopically reparable. Cite this article: Bone Joint J 2016;98-B:1656-61.

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