Thank you to the society for the opportunity to present our work and I'd like to acknowledge my co-authors for their assistance with this project. To begin, we have no disclosures that are relevant but our disclosures are updated and available in the final meeting program. We know that patient outcomes after rotator cuff repair are multifactorial and depend on a number of different factors including demographic characteristics, tear characteristics, muscle quality and others. At the time of arthroscopy, the rates of concurrent glenohumeral arthritic changes range from 13 to 28 percent. But the relationship between these preoperative glenohumeral joint degenerative changes and rotator cuff repair outcomes remains unclear. Semi-quantitative MRI grading offers an improved evaluation of soft tissue structures relative to plain radiographs. These scoring systems have been used more widely in hip and knee arthritis and can often correspond better with outcomes compared to plain radiographs. In 2019, Youngman et al. introduced the shoulder osteoarthritis severity score, the SOAS score. So this is a semi-quantitative whole joint scoring system graded on a 0 to 100 scale with increasing score indicating increasing degenerative changes. It's comprised of sub-scores regarding the rotator cuff which includes muscle quality, tear severity, retraction, the biceps labrum complex, the acromion, subacromial space, glenohumeral cartilage, osseous findings, as well as the joint capsule and synovitis, so a whole joint evaluation of the shoulder. This has a strong correlation with Kellgren-Lawrence and Samuelson-Prieto classifications, but it really can detect early degenerative changes when the radiographs are still normal. So the purpose of this study was to investigate the relationship of preoperative MRI-based shoulder joint scoring system with postoperative patient-reported outcomes after rotator cuff repair. Our hypothesis was that preoperative SOAS score will be negatively correlated with postoperative patient-reported outcomes after cuff repair. To accomplish this, we performed a retrospective study including 77 patients after arthroscopic rotator cuff repair. Our inclusion criteria consisted of an MRI within one year of surgery, as well as minimum 15-month follow-up. We excluded anyone with an inadequate MRI, shoulder dislocation, revision cuff repair, or open cuff repair. The PRO collection was the PROMIS upper extremity, so this was completed at a mean of 42.9 months. This has been validated in rotator cuff repair patients. It correlates with legacy outcome measures like the ASES score, and importantly, a value of 50 with this should correspond to the population mean. The MRIs were evaluated by an MSK radiologist as well as an orthopedic surgeon. Overall, we had an ICC of 0.63 for the total SOAS score. We then used an average value between those two readers as our measure for our final analysis. Our stats consisted of Spearman rank correlation for univariate evaluation to compare total SOAS score and the PROMIS upper extremity scores, as well as those sub-scores with the PROMIS score. We then performed multivariate linear regression modeling to predict the PROMIS upper extremity score as a function of the SOAS score and potential covariates, including age, BMI, and patient sex. For our patient characteristics, we had a mean age of 62, 44% women, BMI of 27, and that mean follow-up of 43 months. The post-operative PROMIS upper extremity score mean was 51.5, so just slightly above that population mean, with a range from 25 to 56. Our total SOAS score, so that preoperative MRI measurement was 21, which corresponds to mild degenerative changes. And then you can see the breakdown. So here, this is that sub-score. Most of those points are coming from the rotator cuff, with some coming from labrum, acromion, cartilage, osteous findings, and the least from the joint capsule. In univariate analysis, we found a significant correlation between the total SOAS score and the PROMIS upper extremity score, with a row of minus .24. And then, in the sub-scores, we found that both the cartilage and the AC joint degeneration were significantly correlated with the PROMIS upper extremity score. Cartilage of .33, and AC joint of .24. And so what this is saying is increasing joint degeneration as measured on the SOAS score is associated with worse post-operative PROMIS upper extremity scores. We also found a significant correlation between the total SOAS score and age, with a row of .49. And the increasing SOAS score was seen in older patients, which I think makes sense. Through multivariate analysis, so we constructed three models to model the total SOAS score, the cartilage sub-score, and then the AC sub-score, while controlling for age, sex, and BMI. And through these, so we found that only the cartilage sub-score was a significant independent predictor when controlling for those demographic variables. And that P value is .038, with a beta coefficient of negative one. So through this work, we found that increasing preoperative total SOAS score is correlated with lower PROMIS upper extremity scores following rotator cuff repair, and this seems to be driven most strongly by the cartilage sub-score, so this was independent in multivariate regression modeling. Prior research on this topic has been unclear, but it has primarily defined OA on radiographs. Our study does have some limitations. It's a retrospective study. We did not have preoperative PROs. Our cohort does have lower levels of degenerative changes, but I would argue it represents a real-world cohort of patients undergoing rotator cuff repair. So with conclusions, so an increasing preoperative shoulder joint degenerative change with the MRI-based SOAS score is negatively correlated with the PROMIS upper extremity score. The whole joint degenerative changes, even at lower levels, should be considered in treating rotator cuff tears. And I do think future research can help clarify the specific clinical role for this scoring system. So, thank you all. Thank you.

MRI-based shoulder joint scoring system

postoperative patient-reported outcomes

rotator cuff repair

preoperative scores

cartilage degeneration