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Most Reliable Method to Classify Rotator Cuff Tears

There are at least six ways to describe or classify rotator cuff tears (RCTs). Which one is best? Which one gives the same results no matter who uses it? Finding a reliable way to classify RCTs will help doctors understand and treat this condition.

In this study, a large group of orthopedic surgeons try to find the classification system with the best interobserver agreement. That means everyone using the system comes out with the same (or close) results for each patient.

Arthroscopic videos of 30 patients with partial or full-thickness RCTs were examined by 12 orthopedic surgeons. All 12 were fellowship-trained shoulder surgeons who repair more than 30 RCTs each year.

Each surgeon classified the patients according to size, shape, and depth of the tear. The number of tendons involved and other details were also noted. Analysis of the results showed that experienced shoulder surgeons could identify a partial versus full-thickness RCT.

There was also good agreement about which side of the joint was involved. Depth of tears was not as easy to evaluate. There was poor interobserver agreement for this category. Classification by size (small, medium, large, massive) was fairly subjective. It didn't take into consideration the size of the patient's bone or other anatomy.

It is important to find a way to classify RCTs that is precise and consistent. Using arthroscopic video is best when the surgeon can also conduct the study him or herself (as opposed to just watching the video).

The questionnaire used in this study had good interobserver agreement. The next step is to test for accuracy. Both high interobserver agreement and accuracy are needed in finding the best method of RCT classification.


John E. Kuhn, et al. Interobserver Agreement in the Classification of Rotator Cuff Tears. In The American Journal of Sports Medicine. March 2007. Vol. 35. No. 3. Pp. 437-441.

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