Summary

This study aimed to assess the temporal changes in magnetic resonance imaging (MRI) appearance after arthroscopic rotator cuff repair with superior capsule reconstruction for reinforcement (SCR-R). SCR-R prevented postoperative retear even in severely degenerated tendon tears. The MRI appearance of repaired tendon and graft continued to mature during 2-year follow-up.

Abstract

Introduction

Retearing of repaired rotator cuff tendons often worsens clinical outcomes and decreases patient satisfaction after arthroscopic rotator cuff repair. Recently, arthroscopic rotator cuff repair with superior capsule reconstruction for reinforcement (SCR-R) was developed to improve the repair integrity and prevent retear of the repaired tendon for the treatment of degenerated rotator cuff tears. However, there have been no study which assessed the temporal changes in the structural integrity of repaired tendons and graft on magnetic resonance imaging (MRI) after SCR-R. Hence, this study aimed to assess the temporal changes in MRI findings after SCR-R.

Methods

We retrospectively reviewed 33 consecutive patients (11 men and 22 women; mean age:71.0 years) with degenerated rotator cuff tears (thin and/or fatty degenerated tendon) who underwent SCR-R and completed postoperative MRI examinations at 3, 6, 12, and 24 months. Thirty tears were medium and three were large tears. Seven shoulders had isolated supraspinatus tears, 23 shoulders had two tendon tears (supraspinatus and infraspinatus or supraspinatus and subscapularis), and three shoulders had three tendon tears (supraspinatus, infraspinatus, and subscapularis). The Goutallier grade of supraspinatus was 1–3. We assessed the postoperative repair integrity using the Sugaya classification and the high-intensity area between the repaired tendon and graft at 3, 6, 12, and 24 months. The McNemar test was used for the statistical analysis. Statistical significance was defined as P < .05.

Results

None of the 33 patients had postoperative retears after SCR-R. Regarding repair integrity, five shoulders were type I and 28 were type II at 3 months; 10 were type I and 23 were type II at 6 months; 21 were type I, 10 were type II, and two were type III at 12 months; 26 were type I, 5 were type II, and two were type III at 24 months. There were 15%, 30%, 64%, and 79% type I shoulders at 3, 6, 12, and 24 months, respectively, with a significant increase between 6 and 12 months (P = 0.002). As for the high-intensity area between the repaired tendon and graft, there were 28, 23, 12, and 4 shoulders with high-intensity areas at 3, 6, 12, and 24 months, respectively. The rate of shoulders with high-intensity area between repaired tendon and graft was 85%, 70%, 36%, and 12% at 3, 6, 12, and 24 months, respectively, with a significant decrease between 6 and 12 months (P = 0.002) and between 12 and 24 months (P = 0.005).

Discussion And Conclusion

SCR-R prevented postoperative retear of the repaired rotator cuff tendon even in severely degenerated tendon tears. During the 2-year follow-up after SCR-R, the MRI appearance of repaired tendons and grafts continued to mature. Furthermore, the rate of high-intensity areas between the repaired tendons and grafts continued to decrease. These results suggest that graft-to-tendon healing may occur following SCR-R.