Good morning, thank you for the opportunity to share our work. Here are relevant financial disclosures. Currently we all use the Goutelier classification to evaluate overall tissue quality in the assessment of rotator cuff pathology. It's a prognostic tool specifically focusing on fatty infiltration of the supraspinatus. As surgeons, this is clinically important to us as it guides our decision-making, specifically in the setting of massive rotator cuff tear. Our options include joint preserving procedures versus total shoulder orthoplasty. However, there are several well-described limitations to the Goutelier classification system, which include a high inner observer variability, as well as an assessment that's focused on a two-dimensional cut of a single rotator cuff muscle. Additionally, the classification system is unable to account for the disconnect between intramuscular fat infiltration and extramuscular fat replacement. Therefore, in order to provide a more comprehensive assessment of the rotator cuff unit, a novel 3D MRI-based volumetric assessment has been introduced. Sagittal T1 shoulder MRI scans are vetted through a proprietary AI computer algorithm to develop volumetric scores that are then compared to a database of age-matched normative controls. The purpose of our study was to describe a correlation between Goutelier and our volumetric scores in evaluation of the supraspinatus, as well as to characterize the overall health of the rotator cuff unit through volumetric analysis, with the overall goal of comparing Goutelier scores to our volumetric scores and their ability to predict preoperative functional disability. The volumetric scores are comprised of three individual scores that are each individually measured for each muscle in the rotator cuff unit, the first being fat infiltration, which is the percentage of intramuscular fat infiltration weighted by the relative volume contribution. The second is the muscle size, which is the average muscle volume compared to our database of controls. Lastly, the relative contribution score is the weighted average of each muscle's relative volume contribution to the entirety of the rotator cuff unit. We identified a cohort of patients that underwent arthroscopic rotator cuff repair with five preoperative scores that were obtained, the first being the Goutelier classification, which was independently graded by two surgeons, followed by our battery of volumetric scores, which again were each measured for the individual rotator cuff muscles. Lastly, preoperative promise, physical function, and pain interference scores were obtained. A database of age-matched asymptomatic controls was developed in order for the AI database to account for patient size and the variability in lateral to medial scan coverage on MRI. Here are the demographics from our study. We had 82 patients with an average age of 55 and a one-third female to male ratio. The vast majority of our patients were either grade 0 or 1 Goutelier scores with an interclass correlation coefficient of 0.8. In evaluation of the supraspinatus, we compared our volumetric scores to the Goutelier scores, which found a moderate strong correlation with fat infiltration and strong negative correlation with both muscle size and relative volume contribution. Again, when looking at just the supraspinatus, the relative volume contribution score was the strongest correlation with the Goutelier scores. Now what's most clinically relevant to us as surgeons is the ability to take a preoperative MRI-based assessment and predict functional disability. Our scores, our results demonstrated a negligible correlation with Goutelier scores to preoperative functional disability, which was defined by PROMIS physical function and pain interference scores. On the contrary, there were several volumetric scores that were moderate predictors of preoperative functional disability. What I want to point out here is that you see several of the rotator cuff muscles represented. Additionally, muscle size and fat infiltration seemed to have the most significant prognostic value. The results from our study demonstrate a high correlation between Goutelier and our volumetric scores, specifically an evaluation of the supraspinatus. This is not a surprise as this is the basis of the Goutelier classification system. Although considered gold standard in evaluation of rotator cuff pathology, the Goutelier scores had a negligible correlation with preoperative functional disability. Yet, on the contrary, there were several volumetric scores that more strongly correlated with preoperative functional disability, which suggests that our novel 3D MRI-based volumetric assessment may provide a more comprehensive evaluation of the entirety of the rotator cuff unit. Thank you. �

Goutelier classification system

rotator cuff pathology

3D MRI-based volumetric assessment

functional disability

novel assessment