Rotator cuff tear (RCT) is one of the most common shoulder injuries. When diagnosing RCT, skilled orthopedists visually interpret magnetic resonance imaging (MRI) scan data. For automated and accurate diagnosis of RCT, we propose a full 3D convolutional neural network (CNN) based method using deep learning. This 3D CNN automatically diagnoses the presence or absence of an RCT, classifies the tear size, and provides 3D visualization of the tear location. To train the 3D CNN, the Voxception-ResNet (VRN) structure was used. This architecture uses 3D convolution filters, so it is advantageous in extracting information from 3D data compared with 2D-based CNNs or traditional diagnosis methods. MRI data from 2,124 patients were used to train and test the VRN-based 3D CNN. The network is trained to classify RCT into five classes (None, Partial, Small, Medium, Large-to-Massive). A 3D class activation map (CAM) was visualized by volume rendering to show the localization and size information of RCT in 3D. A comparative experiment was performed for the proposed method and clinical experts by using randomly selected 200 test set data, which had been separated from training set. The VRN-based 3D CNN outperformed orthopedists specialized in shoulder and general orthopedists in binary accuracy (92.5% vs. 76.4% and 68.2%), top-1 accuracy (69.0% vs. 45.8% and 30.5%), top-1±1 accuracy (87.5% vs. 79.8% and 71.0%), sensitivity (0.94 vs. 0.86 and 0.90), and specificity (0.90 vs. 0.58 and 0.29). The generated 3D CAM provided effective information regarding the 3D location and size of the tear. Given these results, the proposed method demonstrates the feasibility of artificial intelligence that can assist in clinical RCT diagnosis.

PurposeThis study aimed to compare the clinical results of revision Bankart repair versus the Latarjet procedure for failed Bankart repair. MethodsA literature search was performed in databases, such as Pubmed, Embase, and Scopus Library. The studies were appraised using the Methodological Index for Non‐randomized Studies tool. Studies for failed Bankart repair with revision Bankart repair or Latarjet procedure were included. The pain VAS, ROWE score, rate of return to sports and preinjury level of sports, recurrent instability, range of motion, and complications were compared. Additionally, the pain VAS, ROWE score, forward flexion, and external rotation at side were subjected to a meta‐analysis. ResultsTwenty‐four articles were included in the systematic review. The functional outcomes in terms of the ROWE score, recurrent instability, return to sports, and the preinjury level of sports was better in the Latarjet procedure group than those in the revision Bankart repair group (ROWE score, 91 vs. 86.7; recurrent instability rate, 3.5% vs. 14.4%; return to sports rate, 100% vs. 87.9%; return to preinjury level of sports rate, 89.9% vs. 74.9%; all P < 0.001). However, the results of postoperative pain and the postoperative limitation of external rotation at side were worse in the Latarjet procedure group than those in the revision Bankart repair group (pain VAS, 1.4 vs. 0.8; postoperative external rotation at side, 38° vs. 60°; all P < 0.001). In addition, the majority of the complications occurred in the Latarjet procedure group. In the meta‐analysis, the postoperative ROWE score was significantly higher in the Latarjet procedure group than that in the revision Bankart group (revision Bankart repair: 95% CI 88.9–80.9, I2 = 65.70; Latarjet procedure: 95% CI 95.8–88.1, I2 = 93.37; P = 0.014). However, the pain VAS, forward flexion, and external rotation at side did not reach the significant level in the meta‐analysis. ConclusionCompared with revision Bankart repair, the Latarjet procedure for failed Bankart repair showed better ROWE scores, stability, and return to sports or preinjury level of sports; however, the postoperative pain and the limitation of external rotation at side were worse with more complications. IRB NoKUMC 2022–01‐024. Level of evidenceLevel IV.

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Background: In large-sized rotator cuff tears, tendon repair with incomplete footprint coverage is performed frequently as a way of tension-free or low-tension repair. Purpose: To compare clinical outcomes after arthroscopic repair of large-sized rotator cuff tears between patients with complete versus incomplete footprint coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Among 297 patients who underwent arthroscopic surgery for a large-sized rotator cuff tear, we selected 58 patients (<50% coverage; mean age, 63.34 ± 6.8 years; 34 men and 24 women) with incomplete footprint coverage. Using propensity score matching, another 58 patients with complete footprint coverage (mean age, 63.4 ± 8.03 years; 34 men and 24 women) were selected after 1:1 matching for age, sex, and tear size—the main demographic and prognostic factors of outcomes after rotator cuff repair. Clinical outcomes were compared on magnetic resonance imaging or ultrasonography at minimum of 6 months postoperatively, and functional outcomes were compared using range of motion and pain visual analog scale; American Shoulder and Elbow Surgeons; Constant; University of California, Los Angeles; and Simple Shoulder Test scores at a minimum of 2 years postoperatively. Results: A total of 18 patients in the incomplete footprint coverage group (31.0%) and 20 patients in the complete footprint coverage group (34.5%) showed healing failure, with no significant difference between groups ( P = .843). In addition, there were no differences in functional outcomes between groups ( P > .05 for all). Conclusion: Whether the rotator cuff footprint was completely covered did not affect clinical outcomes in conventional arthroscopic repair of large-sized rotator cuff tears.