Acta Ortopédica Mexicana

Guerra-Soriano F, Ruiz-Suárez M, Encalada-Díaz MI, Pérez-Domenech J, Moscona-Mishy L, Valero-González FS
The Seebauer classification for the staging of rotator cuff massive tear arthropathy: intra- and interobserver concordance analysis
Acta Ortop Mex 2010; 24 (6)

Language: Español
References: 15
Page: 390-394
PDF: 0. Kb.

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Introduction: L Seebauer developed a radiologic classification of arthropathy due to massive rotator cuff tear, based on the medial and/or proximal displacement of the humeral head as a result of disease progression. The purpose of this paper is to conduct an evaluation of the concordance of such classification. Methods: A group of 34 patients with massive rotator cuff lesion was created. Their X-rays were reviewed and classified by 5 independent observers. An inter- and intraobserver concordance analysis was carried out using the Kappa index, and the results were interpreted according to the Landis and Kock criteria. Results: The intraobserver concordance determined for the 5 observers showed that the one with the greatest experience had an agreement close to 100%; the interobserver concordance found that only 2 of the 5 observers had moderate agreement and, finally, the interobserver concordance of the stages of classification 2A showed a substantial agreement, while a moderate agreement was found for IA and IB. Discussion: An important variability was found in the intraobserver concordance, where the capacity to reproduce the same results depends on the observer’s experience. The results of the interobserver concordance show that the criteria established by Seebauer are insufficient to be reproduced. Finally, in the concordance among the stages a moderate agreement was found in each of the stages. Conclusion: The results of this paper show that the Seebauer classification is experience-dependent, which hinders its routine use by orthopedists not sufficiently trained on shoulder surgery or by residents in training.

Key words: shoulder, classification, arthroplasty, rotator cuff.


  1. Neer CS, Craig EV, Fukuda H: Cuff tear arthropathy. J Bone Joint Surg Am 1983; 65-A(9): 1234-44.

  2. Patte D: Classification of rotator cuff lesions. Clin Orthop Relat Res 1990; 265: 81-6. DOI:10.1097/00003086-199005000-00012.

  3. Thomazeau H, Rolland Y, Lucas C: Atrophy of the supraspinatus belly. Assesment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 1996, 67(3): 264-8.

  4. Goutallier D, Postel J, Bernageau J: Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994, 304: 78-83. DOI: 10.1097/00003086-199407000-00014.

  5. Vad VB, Warren RF, Altchek DW, O’Brien SJ, Rose HA: Negative prognostic factor in managing massive rotator cuff tears. Clin J Sport Med 2002; 12(3): 151-7. DOI:10.1097/01.blo.0000196043.34789.73.

  6. Sirveaux F, Favard L, Oudet D, Hoquet D, Walch G, Mole D: Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. J Bone Joint Surg Br 2004; 86-B(3): 388-95. DOI:10.1302/0301-620X.86B3.14024.

  7. Nove-Josserand L, Edwads TB, O’Connor DP, Walch G: The acromiohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res 2005; 433: 90-6. DOI:10.1097/01.blo.0000151441.05180.0e.

  8. Van de Sande MAJ, Rozing PM: Proximal migration can be measured accurately on standardized AP shoulder radiographs. Clin Orthop Relat Res 2006; 443: 260-5. DOI:10.1097/01.blo.0000196043.34789.73.

  9. Hamada K, Fukuda H, Mikasa M, Kobayashi Y: Roentgenographic findings in massive rotator cuff tears. Clin Orthop Relat Res 1990; 254: 92-6. DOI:10.1097/00003086-199005000-00014.

  10. Visotsky JL, Bassamania C, Seebauer L, Rockwood CA, Jensen KL: Cuff tear arthropathy: Pathogenesis, classification and algorithm for treatment. J Bone Joint Surg Am 2004; 86-A(2): 35-40.

  11. Landis JR, Koch GG: «The measurement of observer agreement for categorical data» in Biometrics. 1977; 33: 159-74. DOI:10.2307/2529310.

  12. Iannotti JP, McCarron J, Raymond CJ, Ricchetti ET, Abboud JA, Brems JJ, Williams GR: Agreement study of radiographic classification of rotator cuff tear arthropathy. J Shoulder Elbow Surg 2010; 19(8): 1243-9. DOI:10.1016/j.jse.2010.02.010.

  13. Reilly P, MacLeod I, MacFarlane R, Windley J, Emery RJH: Dead men and radiologist don’t lie: Review of cadaveric and radiological studies of rotator cuff prevalence. Ann R Coll Surg Eng 2006; 88: 116-21. DOI:10.1308/003588406X94968.

  14. Milgrom C, Schaffler M, Gilbert S, Van Holsbeeck M: Rotator-cuff changes in asymptomatic adults. J Bone Joint Surg Br 1995; 7-B(2): 296-8.

  15. Yao J, Dines DM, Warren RF: Surgical arthroplasty options for rotator cuff tear arthropathy. Tech Shoulder Elbow Surg 2003; 4(1): 26-34. DOI:10.1097/00132589-200303000-00004.