Radiological evaluation of rotator cuff healing and its clinical correlation after arthroscopic repair of rotator cuff tear by single row technique
Authors:
Dr Vinod Kumar, Dr Rakesh Sehrawat, Dr Ananya Sharma
Maulana Azad Medical College, New Delhi, INDIA
Introduction
The absence of repaired rotator cuff tendon healing has been correlated with inferior strength. Evaluation of anatomic healing and integrity of rotator cuff is crucial for assessing the outcome of arthroscopic rotator cuff repair (ARCR). The purpose of study is to assess functional outcomes of ARCR and correlate it with anatomic healing observed on MRI.
Materials And Methods
Study was conducted on 24 patients with symptomatic full or partial thickness (=50%) rotator cuff tear. Preoperatively patients were evaluated with functional outcome scores (VAPS, ASES, CMS and UCLA) and MRI. Postoperatively VAPS was recorded at 6weeks, 3months, 6months and 1 year and ASES, CMS and UCLA were recorded at 3 months, 6 months and 1 year. Healing of repaired rotator cuff tendon was evaluated with MRI using Sugaya classification at 1 year.
Results
Statistically significant improvement (p=0.0001) in the functional outcome measures namely VAPS, ASES, CMS, and UCLA was found. VAPS improved form 6.67 ± 1.15 to 0.39 ± 0.56 at 1 year, ASES from 34.44 ± 12.31 to 94.16 ± 7.91, CMS from 29.33 ± 7.25 to 86.46± 7.92 and UCLA improved from 10.08 ± 2.50 to 33.84± 3.27 at 1 year follow up. The retear rate was 8.33%. On postoperative MRI, 75%patients had sufficient thickness of rotator cuff tendon (Sugaya type1 and type2); 16.67%patients had insufficient thickness of repaired tendon, but continuity was maintained (type 3) and 8.33%patients had full thickness tear(type 5). Statistically significant improvement (p<0.0001) was observed in functional outcome scores across all types of tendon healing. There is no statistically significant difference in functional outcome scores between Sugaya type 1,2 and 3.However the clinical outcome of type 5 is inferior to the type 1,2 and 3, and this difference is statistically significant.
Conclusion
MRI is a good imaging modality for postoperative evaluation of tendon healing. There is no clinical correlation amongst different types of repaired rotator cuff tendon healing from type 1 to type 3 as per Sugaya classification. The clinical correlation exists only between full thickness retear (Sugaya type 5) and healed tendon with maintained continuity (Sugaya type 1 to 3). There was no patient in our study with Sugaya type 4 tendon healing on MRI, so we cannot comment on its correlation with clinical outcome.