2015 ISAKOS Biennial Congress ePoster #2407
Evaluation of Temporal Changes in Rotator Cuff Integrity With MRI After Arthroscopic Rotator Cuff Repair
Mitsuhiro Enomoto, MD, Koshigaya, Saitama JAPAN
Kazufumi Sano, MD, PhD, Koshigaya JAPAN
Satoru Ozeki, MD, PhD, Koshigaya, Saitama JAPAN
Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, JAPAN
FDA Status Not Applicable
Summary: Post-ARCR images at 3,6,12 and 24 months reveal that all re-tear occurred within 6 months. Of 2 failure types, medial failure was seen at 6 months in 3 shoulders, and lateral failure at 3 and 6 months in 7 and 1 shoulders respectively. 12 of 21 shoulders which were Type II three months after surgery improved to Type I for complete repair within an estimated 12 months.
There are few reports evaluating MRI images over time after arthroscopic rotator cuff repair (ARCR) to show the timing and exact location of re-tears. As this data is important for better results, we set out to evaluate the progression of follow-up MRI images after ARCR.
Materials And Methods
A retrospective review of 64 patients with partial to massive rotator cuff tears who underwent ARCR by the same surgeon between June 2010 and April 2012. Of these patients, 13 were excluded because of incomplete follow-up data, leaving 51 shoulders, including 31 male and 20 female with an average age of 66.0 years. The tear size was partial in five, small in four, medium in twenty four, large in seventeen and massive in one. Six shoulders were repaired using a single-row, 18 using a double-row, and 27 using suture bridge techniques. Outcome measures including American Shoulder and Elbow Surgeons score (ASES score) and range of motion (ROM) were assessed. Post-operative cuff integrity was determined using Sugaya’s MRI classification at 3, 6, 12, and 24 months after surgery. Shoulders that were type IV and V at the 24-month follow-up were determined to be re-tear and were divided into two groups: medial failure being re-tear around the medial anchors with well healed tendon on the footprint, and lateral failure being re-tear from the footprint.
At a mean follow-up of 31.2 months, ASES scores improved significantly from 46.8 to 89.2. ROM improved by 16.5 degrees for elevation, 5.6 degrees for external rotation, and 1.5 vertebral bodies for internal rotation. Final follow-up MRI findings were classified as Type I in 28 patients, Type II in 10, Type III in 2, Type IV in 5, Type V in 6. The overall re-tear rate (Type IV and V) was 21.6%. At 3 and 6 months 7 and 4 shoulders respectively showed re-tear, and all re-tears were seen within 6 months. Medial failure was seen in 3 shoulders at 6 months, while lateral failure was seen at 3 and 6 months in 6 and 1shoulders respectively. 12 of 21 shoulders which were Type II three months after surgery improved to Type I. Time to improvement was 6, 12 and 24 months for 6, 5 and 1 patients respectively.
The period of risk for re-tear was from surgery to 6 months. Especially in large massive tears, re-tears were found without any traumatic episode 6 months after repair. No re-tear was seen after 12 months, and tendon repair, indicated by decreasing signal intensity of the repaired area, was considered complete by 12 months after surgery. The medial failures were all large tears that had improved to Type II at 3 months, but then showed re-tear at six months. Therefore we recommend avoiding excessive activity beyond 6 months in such patients. Of the 21 shoulders that were Type II at three months post-op, three of the four large tears had re-tears at six months, so for high stress tendons there is a danger of re-tear well past three months.