Aim
The study aims to find an association between the healing of the rotator cuff on magnetic resonance imaging (MRI) scan and functional outcomes. Study design: Prospective cohort study
Background
The natural history of rotator cuff tears is poorly understood. There are patients with complete tears who remain asymptomatic, whereas smaller or even partial thickness tears may be symptomatic. Similarly, it is not known whether healing of the tendon after the surgery correlates with the functional outcomes. Factors affecting outcomes in patients of rotator cuff tears are not fully understood. Lack of healing or retears may be seen after arthroscopic rotator cuff repair. Despite re-tears, clinical outcomes in these patients may vary. There is limited evidence from MRI-based studies comparing radiological outcomes of rotator cuff repairs with functional outcomes.
Methods
The study included patients with full-thickness rotator cuff tears undergoing arthroscopic rotator cuff repair. The patients were followed up clinically and a follow-up MRI scan was performed two years after the surgery. Association between radiological healing based on Sugaya grading and functional outcome scores was analyzed. Postoperative parameters evaluated were: mean active range of abduction, abduction strength, external rotation strength, University of California at Los Angeles score, Constant score, American Shoulder and Elbow Surgeons scores and Visual Analog Scale for pain. Tear characteristics (tear size, muscle atrophy, fatty degeneration) were also correlated with healing.
Results
The study included 60 patients (35 females and 25 males), with a mean age of 58 years (standard deviation 8.6 years). The mean duration of symptoms was 4.5 months. All functional outcome scores showed a significant improvement at follow-up of two years as compared to the baseline pre-operatively. No significant association could be seen between the Sugaya grading of MRI-based rotator cuff healing and improvement in functional outcome scores at follow-up. Sugaya grade 1 healing was seen in 25 patients, grade 2 healing was seen in 28 patients and grade 3 healing was seen in seven patients. The increased duration between injury and surgery was associated with higher grades of fatty infiltration of the muscle and higher Sugaya grades after the surgery.
Conclusion
The study suggests that structural healing of the rotator cuff as assessed by post-operative MRI scans may not correlate with improvement in functional outcomes after the surgery. Early repair of the rotator cuff results in better functional outcomes and shoulder strength.