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SLAP Lezyonlarının MRG ve Artroskopik karşılaştırması

Yıl 2021, Cilt: 43 Sayı: 3, 258 - 265, 07.05.2021
https://doi.org/10.20515/otd.864773

Öz

Superior labrum anterior-posterior (SLAP) yırtıkları ortopedi hastalarında omuz ağrısı kaynaklarındandır. Manyetik rezonans görüntüleme (MRG) bu hastalarda teşhis için gereklidir. Bu çalışmanın amacı SLAP lezyonlarının MRG ve artroskopi değerlendirmeleri arasındaki uyumu göstermektir. Çalışma Nisan 2019- Mayıs 2020 tarihleri arasında varolan omuz patolojisi için omuz artroskopi cerrahisine giden yaş ortalamsı 50.40 (aralık: 19-74 yaş) olan, 32 kadın ve 20 erkek içeren toplam 52 hastadan oluşmaktadır. 34 hastada (%65) sağ, 18’ nde (%35) sol omuz etkilenmişti. Hastalarda ameliyat öncesi teşhis; rotator kaf sendromu (n:34), impingement sendromu (n:7), donuk omuz (n:2) ve bankart lezyonu (n:9) idi. MRG yapıldıktan sonra omuz artroskopisi yapıldı. Sadece artroskopik değerlendirmede SLAP tip sınıflaması tespit edildi ve 13 Tip 1 (%33), 23 Tip 2 (%58), bir Tip 3 (%3), bir Tip 4 (%3) ve 1 Tip 5 (%3) lezyon mevcut idi. Oniki hastada hem MRG hemde artroskopi de SLAP lezyonları saptandı. MRG de SLAP lezyon olmasına rağmen 3 hastada artroskopik olarak lezyon saptanmadı. 10 hastada hem artroskopi hem de MRG de SLAP lezyonu yoktu. 27 hastada MRG de lezyon yok iken, artroskopi de lezyon saptandı. SLAP lezyonlarının teşhisinde, MRG %31 duyarlılık, %77 özgüllük, %80 pozitif öngörme değeri ve %27 negatif öngörme değeri gösterdi. MRG’ nin doğruluğu %42 olarak bulundu. MRG ve artroskopi arasında anlaşmanın güvenilirliği (Fleiss kappa) 0.048 (p=0.596) olarak bulundu. MRG diğer omuz patolojilerini teşhis etmekte yararlı bir araç olmasına ragmen, altın standart olan omuz artroskopisine kıyasla SLAP lezyonlarını tespit etmekte yeterli değildir.

Kaynakça

  • 1. Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports. 1985;13(5):337–41.
  • 2. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.
  • 3. Alpantaki K, McLaughlin D, Karagogeos D, Hadjipavlou A, Kontakis G. Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am. 2005;87(7):1580–3.
  • 4. Maffet MW, Gartsman GM, Mosely B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23;1:93-8.
  • 5. Powell SE, Nord KD, Ryu RK. The diagnosis, classification, and treatment of SLAP lesions. Oper Tech Sports Med. 2004;12:99–110.
  • 6. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995;4;4:243-8.
  • 7. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg. 2012;21(1):13–22.
  • 8. Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder R. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2645-50.
  • 9. Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR. Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior–posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elbow Surg. 2006;15(5):580–5.
  • 10. Kwak SM, Brown RR, Resnick D, Trudell D, Applegate GR, Haghighi P. Anatomy, anatomic variations, and pathology of the 11- to 3-o’clock position of the glenoid labrum: findings on MR arthrography and anatomic sections. Am J Roentgenol. 1998;171(1):235–8.
  • 11. McFarland EG, Tanaka MJ, Garzon-Muvdi J, Jia X, Petersen SA. Clinical and imaging assessment for superior labrum anterior and posterior lesions. Curr Sports Med Rep. 2009;8:234-9.
  • 12. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D. A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med. 2013;41(4):880-6.
  • 13. Phillips JC, Cook C, Beaty S, Kissenberth MJ, Siffri P, Hawkins RJ. Validity of noncontrast magnetic resonance imaging in diagnosing superior labrum anterior-posterior tears. J Shoulder Elbow Surg. 2013;22(1):3-8.
  • 14. Connell DA, Potter HG, Wickiewicz TL, Altchek DW, Warren RF. Noncontrast magnetic resonance imaging of superior labral lesions: 102 cases confirmed at arthroscopic surgery. Am J Sports Med. 1999;27:208-13.
  • 15. Magee T 3-T MRI of the shoulder: is MR arthrography necessary? Am J Roentgenol. 2009; 192(1):86–92.
  • 16. Legan JM, Burkhard TK, Goff WB 2nd, Balsara ZN, Martinez AJ, Burks DD, Kallman DA, O’Brien TJ, Lapoint JM. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology. 1991;179(1):241–6.
  • 17. Connolly KP, Schwartzberg RS, Reuss B, Crumbie D Jr, Homan BM. Sensitivity and specificity of noncontrast magnetic resonance imaging reports in the diagnosis of type-II superior labral anterior–posterior lesions in the community setting. J Bone Jt Surg Am. 2013;95(4):308–13.
  • 18. Yıldız F, Bilsel K, Pulatkan A, Uzer G, Aralaşmak A, Atay M. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg. 2017;137(2):241-7.
  • 19. Burkhart SS, Sanders TG, Denard PJ, Parsley BK. MRI and arthroscopy correlations of the shoulder: a case-based approach. Instr Course Lect. 2012;61:185-200.
  • 20. Tuite MJ, Petersen BD, Wise SM, Fine JP, Kaplan LD, Orwin JR. Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skeletal Radiol. 2007;36:495-502.
  • 21. Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. AJR Am J Roentgenol. 2006;187:1448-52.
  • 22. Field LD, Savoie FH. Arthroscopic suture repair of superior labral detachment lesions of the shoulder. Am J Sports Med. 1993;21;6:783-90.
  • 23. Liu S, Henry MH, Nuccion S, Shapiro MS, Dorey F. Diagnosis of glenoid labral tears. A comparison between magnetic resonance imaging and clinical examinations. Am J Sports Med. 1996;24;2:149-54.
  • 24. Bhatnagar A, Bhonsle S, Mehta S. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology. J Clin Diagn Res. 2016;10(2):RC18-21.
  • 25. Herold T, Bachthaler M, Hamer OW, Hente R, Feuerbach S, Fellner C, Strotzer M, Lenhart M, Paetzel C. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Radiology. 2006;240(1):152-60.
  • 26. Tirman PF, Bost FW, Steinbach LS, Mall JC, Peterfy CG, Sampson TG, Sheehan WE, Forbes JR, Genant HK. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology. 1994;192(3):851-6.
  • 27. Lee SY, Lee JK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results. Radiology. 2002;224:470–6.

Comparison of SLAP Lesions on MRI and Arthroscopy

Yıl 2021, Cilt: 43 Sayı: 3, 258 - 265, 07.05.2021
https://doi.org/10.20515/otd.864773

Öz

Superior labrum anterior-posterior (SLAP) tears are a source of shoulder pain in orthopaedic patients. Magnetic resonance imaging (MRI) is a necessary tool for diagnosis in these patients. The aim of this study was to show correlation between MRI and arthroscopy evaluations of SLAP lesions. The study included a total of 52 patients, comprising 32 females and 20 males with a mean age of 50.40 years (range: 19-74 years) who underwent shoulder arthroscopy surgery for an existing shoulder pathology between April 2019- May 2020. The right shoulder was affected in 34 (65%) patients and the left in 18 (35%). The pre-operative diagnoses were rotator cuff syndrome (n:34), impingement syndrome (n:7), frozen shoulder (n:2) and Bankart lesion (n:9). MRI of the shoulder joint was applied followed by shoulder arthroscopy. Only SLAP type classifications were detected on arthroscopic examination and there were 13 Type 1 (33%), 23 (58%) Type 2, one (3%) Type 3, one (3%) Type 4, and one (3%) Type 5 lesion. SLAP lesions were detected on both MRI and arthroscopy in 12 patients. The lesion could not be detected arthroscopically in 3 patients although MRI reported a SLAP lesion. SLAP lesions were negative on both MRI and arthroscopy in 10 patients. In 27 patients, MRI was negative, but the SLAP lesions were detected in arthroscopy. In the diagnosis of SLAP lesions, MRI showed 31% sensitivity, 77% specificity, 80% positive predictive value, and 27% negative predictive value. The accuracy of MRI was found to be 42%. Reliability of agreement (Fleiss kappa) between MRI and arthroscopy was found to be 0.048 (p=0.596). Although MRI is a useful tool for diagnosing other shoulder pathologies, it is not sufficient for the detection of SLAP lesions compared to gold standard shoulder arthroscopy.

Kaynakça

  • 1. Andrews JR, Carson WG Jr, McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports. 1985;13(5):337–41.
  • 2. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.
  • 3. Alpantaki K, McLaughlin D, Karagogeos D, Hadjipavlou A, Kontakis G. Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am. 2005;87(7):1580–3.
  • 4. Maffet MW, Gartsman GM, Mosely B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23;1:93-8.
  • 5. Powell SE, Nord KD, Ryu RK. The diagnosis, classification, and treatment of SLAP lesions. Oper Tech Sports Med. 2004;12:99–110.
  • 6. Snyder SJ, Banas MP, Karzel RP. An analysis of 140 injuries to the superior glenoid labrum. J Shoulder Elbow Surg. 1995;4;4:243-8.
  • 7. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg. 2012;21(1):13–22.
  • 8. Sheridan K, Kreulen C, Kim S, Mak W, Lewis K, Marder R. Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears. Knee Surg Sports Traumatol Arthrosc. 2015;23(9):2645-50.
  • 9. Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR. Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior–posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elbow Surg. 2006;15(5):580–5.
  • 10. Kwak SM, Brown RR, Resnick D, Trudell D, Applegate GR, Haghighi P. Anatomy, anatomic variations, and pathology of the 11- to 3-o’clock position of the glenoid labrum: findings on MR arthrography and anatomic sections. Am J Roentgenol. 1998;171(1):235–8.
  • 11. McFarland EG, Tanaka MJ, Garzon-Muvdi J, Jia X, Petersen SA. Clinical and imaging assessment for superior labrum anterior and posterior lesions. Curr Sports Med Rep. 2009;8:234-9.
  • 12. Provencher MT, McCormick F, Dewing C, McIntire S, Solomon D. A prospective analysis of 179 type 2 superior labrum anterior and posterior repairs: outcomes and factors associated with success and failure. Am J Sports Med. 2013;41(4):880-6.
  • 13. Phillips JC, Cook C, Beaty S, Kissenberth MJ, Siffri P, Hawkins RJ. Validity of noncontrast magnetic resonance imaging in diagnosing superior labrum anterior-posterior tears. J Shoulder Elbow Surg. 2013;22(1):3-8.
  • 14. Connell DA, Potter HG, Wickiewicz TL, Altchek DW, Warren RF. Noncontrast magnetic resonance imaging of superior labral lesions: 102 cases confirmed at arthroscopic surgery. Am J Sports Med. 1999;27:208-13.
  • 15. Magee T 3-T MRI of the shoulder: is MR arthrography necessary? Am J Roentgenol. 2009; 192(1):86–92.
  • 16. Legan JM, Burkhard TK, Goff WB 2nd, Balsara ZN, Martinez AJ, Burks DD, Kallman DA, O’Brien TJ, Lapoint JM. Tears of the glenoid labrum: MR imaging of 88 arthroscopically confirmed cases. Radiology. 1991;179(1):241–6.
  • 17. Connolly KP, Schwartzberg RS, Reuss B, Crumbie D Jr, Homan BM. Sensitivity and specificity of noncontrast magnetic resonance imaging reports in the diagnosis of type-II superior labral anterior–posterior lesions in the community setting. J Bone Jt Surg Am. 2013;95(4):308–13.
  • 18. Yıldız F, Bilsel K, Pulatkan A, Uzer G, Aralaşmak A, Atay M. Reliability of magnetic resonance imaging versus arthroscopy for the diagnosis and classification of superior glenoid labrum anterior to posterior lesions. Arch Orthop Trauma Surg. 2017;137(2):241-7.
  • 19. Burkhart SS, Sanders TG, Denard PJ, Parsley BK. MRI and arthroscopy correlations of the shoulder: a case-based approach. Instr Course Lect. 2012;61:185-200.
  • 20. Tuite MJ, Petersen BD, Wise SM, Fine JP, Kaplan LD, Orwin JR. Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit. Skeletal Radiol. 2007;36:495-502.
  • 21. Magee TH, Williams D. Sensitivity and specificity in detection of labral tears with 3.0-T MRI of the shoulder. AJR Am J Roentgenol. 2006;187:1448-52.
  • 22. Field LD, Savoie FH. Arthroscopic suture repair of superior labral detachment lesions of the shoulder. Am J Sports Med. 1993;21;6:783-90.
  • 23. Liu S, Henry MH, Nuccion S, Shapiro MS, Dorey F. Diagnosis of glenoid labral tears. A comparison between magnetic resonance imaging and clinical examinations. Am J Sports Med. 1996;24;2:149-54.
  • 24. Bhatnagar A, Bhonsle S, Mehta S. Correlation between MRI and Arthroscopy in Diagnosis of Shoulder Pathology. J Clin Diagn Res. 2016;10(2):RC18-21.
  • 25. Herold T, Bachthaler M, Hamer OW, Hente R, Feuerbach S, Fellner C, Strotzer M, Lenhart M, Paetzel C. Indirect MR arthrography of the shoulder: use of abduction and external rotation to detect full- and partial-thickness tears of the supraspinatus tendon. Radiology. 2006;240(1):152-60.
  • 26. Tirman PF, Bost FW, Steinbach LS, Mall JC, Peterfy CG, Sampson TG, Sheehan WE, Forbes JR, Genant HK. MR arthrographic depiction of tears of the rotator cuff: benefit of abduction and external rotation of the arm. Radiology. 1994;192(3):851-6.
  • 27. Lee SY, Lee JK. Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results. Radiology. 2002;224:470–6.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Cüneyd Günay 0000-0002-5050-3701

Mustafa Kavak 0000-0002-0280-2088

Yayımlanma Tarihi 7 Mayıs 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 43 Sayı: 3

Kaynak Göster

Vancouver Günay C, Kavak M. Comparison of SLAP Lesions on MRI and Arthroscopy. Osmangazi Tıp Dergisi. 2021;43(3):258-65.


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