Role of ultrasound and MRI in the evaluation of postoperative rotator cuff

Sahu, Amit Kumar; Moran, Erin Kathleen; Gandikota, Girish

doi:10.15557/jou.2023.0028

Fig. 1.

Illustration demonstrating the single-row technique of rotator cuff repair

Fig. 2.

A. Long-axis grayscale US image showing intact single-row repaired supraspinatus tendon (arrow). The arrowhead indicates the trough of the greater tuberosity, the site of normally embedded anchor. B. Short-axis US images of the same shoulder show normal bulk of the supraspinatus (SST) and infraspinatus (IST) muscles indicating normal healing of the repaired tendon

Fig. 3.

Proton density fat-suppressed coronal MR image post single-row rotator cuff repair shows an intact postoperative supraspinatus tendon (arrow). Artifacts by the anchor (arrowhead) can be reduced by applying hardware reduction MRI techniques

Fig. 4.

Illustration demonstrating the double-row technique of rotator cuff repair

Fig. 5.

Long-axis grayscale US image shows intact double-row repaired supraspinatus tendon, maintaining the expected tendon volume (asterisk). The arrows indicate anchors of double bundle repair. Overlying deltoid muscle is echogenic, making the visualization of the underlying supraspinatus tendon challenging

Fig. 6.

Illustration demonstrating transosseous-equivalent rotator cuff repair with suture configurations and bridges that are fixed to the head of the humerus

Fig. 7.

Proton density fat-suppressed coronal (A) and sagittal (B) MR images show complete re-tear of repaired supraspinatus tendon, exposing the trough of the greater tuberosity (bracket). Deltoid muscle overlies the trough. Retracted tendon stump now lies at the level of the glenoid (arrow). Note the anchors of the transosseous-equivalent technique (arrowheads) in the humerus, causing minimal artifact, as expected in this technique

Fig. 8.

A. Clinical photograph of passage of dermal allograft for superior capsule reconstruction. The dermal allograft (a) is secured to the glenoid via suture anchors (b). B. Clinical photograph of superior capsule reconstruction. Glenoid sutures have been tied and cut (not visualized). The graft is secured to the greater tuberosity via double-row repair. Courtesy: Dr. Christopher Shultz, University of New Mexico

Fig. 9.

Illustration demonstrating superior capsular repair with dermal allograft which is anchored with the superior glenoid, greater tuberosity, and remnant supraspinatus tendon

Fig. 10.

A. Coronal proton density fat-suppressed MR image of torn dermal allograft shows medial (long arrow) and lateral (short arrow) portions of split graft with a large gap (bracket). B. Arthroscopic image of the same patient. Arthroscope is viewing from a posterior portal in the subacromial space. The medial edge (a) of the graft is split from the lateral edge (b). The humeral head is distal to the graft (c). Courtesy: Dr. Christopher Shultz, University of New Mexico

Fig. 11.

US technique for rotator cuff evaluation. (A.) Patient is seated, with the elbow flexed and the arm abducted to 90 degrees (B.) Modified Crass position to evaluate supraspinatus tendon

Fig. 12.

Long-axis grayscale US image of a complete re-tear of repaired supraspinatus tendon in Crass (A) and modified Crass (B) positions show tear gap (arrows) due to tendon retraction which is occupied by fluid. Note that the tear gap is accentuated in modified Crass position, and the bulk of the stump (asterisk) is reduced. Arrowheads indicate normal anchors

Fig. 13.

Short-axis grayscale (A) and power Doppler (B) US images show thickening and fluid in subdeltoid bursa with power Doppler signal (arrows) two months after rotator cuff repair, representing inflammation. Long head biceps tendon (asterisks) can be seen within the bicipital groove

Fig. 14.

Proton density fat-suppressed coronal MR image shows thinned but intact postoperative supraspinatus tendon (white arrow). There is fluid in subacromial-subdeltoid bursa (black arrow). The tendon-bone interface also appears intact. Note the presence of double-row anchors in the humeral head (arrowheads)

Fig. 15.

Long-axis grayscale US image of intact repaired supraspinatus tendon 12 months after surgery shows normal heterogeneous appearance (arrows). Note the presence of anchors in the humeral head (arrowheads)

Fig. 16.

Long-axis grayscale US image of intact repaired infraspinatus tendon shows normal echogenic suture material (arrow) within the tendon

Fig. 17.

Long-axis grayscale US image of repaired supraspinatus tendon shows a full-thickness re-tear with defect and exposed trough (thick white arrow). Positions of the anchors of double bundle repair could be noted in the humeral head (thin white arrows). Note the retracted tendon stump (asterisk)

Fig. 18.

Proton density fat-suppressed coronal MR image shows a full-thickness supraspinatus tendon re-tear (asterisk–retracted stump) with complete absence of the tendon fibers at the attachment site and the region of tear occupied by fluid (black arrow). The anchors can be seen in place (white arrows)

Fig. 19.

Long-axis grayscale US image of repaired supraspinatus tendon shows the absence of fibers at the site of tendon attachment to greater tuberosity – empty trough sign (white arrow). The avulsed suture anchor appears as echogenic foci in the region of repair (black arrow)

Fig. 20.

Long-axis grayscale US image of repaired supraspinatus tendon (arrow) shows a protruding suture anchor (arrowhead) but intact tendon

Fig. 21.

Long-axis grayscale US image of repaired supraspinatus tendon shows a full-thickness tear of the mid part of the tendon (arrow) with intact stump (asterisk). There is a clumping of fibers and the edges of the re-tear appear ragged and uneven. Note the anchors in the humeral head (arrowheads)

Fig. 22.

Proton density fat-suppressed coronal (A) and axial (B) and T1 sagittal non-fat suppressed (C) MR images post single-row repaired supraspinatus tendon shows a complete re-tear of the tendon (arrow in A). Even in the single-row technique, there are usually two anchors in the same row and orientation (arrowheads in B), and should not be confused with the double-row technique. There is fatty infiltration and atrophy of the supraspinatus and infraspinatus muscles (asterisks in C)

Fig. 23.

Biceps tenodesis. Coronal (A) and sagittal (B) T1 MR images show anchors (thick white arrows) in the distal bicipital groove. The long-head biceps tendon (black arrow in B) is seen close to the anchor. The anchors (thin white arrows) of the rotator cuff repair can also be seen in the humeral head

Fig. 24.

Shoulder arthroplasty. A. Antero-posterior shoulder radiograph demonstrating total shoulder arthroplasty. B. Long-axis grayscale US image of the same shoulder shows continuous and well-defined undamaged supraspinatus tendon (arrow). Echogenic hardware (arrowhead) is seen deep to the tendon in the humerus head

Fig. 25.

Axial T2 MR image demonstrating tear of subscapularis tendon (arrows) eight months after shoulder arthroplasty. Asterisk denotes the implant in the humerus

Fig. 26.

Shear wave US elastography of the supraspinatus tendon. A. Shear wave US elastography long-axis image shows homogenous appearance of the intact postoperative tendon. B. Strain wave US elastography long-axis images of the same shoulder show the tendon as intermediate in firmness. The patient underwent surgery 12 months prior, and elastography demonstrates the intact tendon to be in the normal healing phase