Tendon imaging plays a critical role in evaluating tendon diseases and injuries including mechanical, degenerative, and overuse disease, inflammatory enthesitis, as well as partial and full thickness tears. Ultrasound and magnetic resonance imaging (MRI), each with unique benefits and limitations, are commonly utilized to assist in diagnosing these diseases and conditions. This review delineates important structural properties of tendon and biochemical changes occurring in tendon pathology. This review also examines commonly injured tendons including tendons of the elbow, tendons of the rotator cuff of the shoulder, hip abductor tendons, patellar tendons, and the Achilles tendon to help clinicians better recognize tendon disease. Finally, this paper introduces several emerging imaging techniques including T2 mapping, ultra-short echo time MRI, and sonoelastography as ways in which tendon imaging and evaluation may be improved.

The degree of tendinopathy did not correlate with morphological appearance of the tendon. Neither of these parameters correlated with healing or patient outcome. This study suggests that the degree of tendinopathy, unlike muscle atrophy, may not be predictive of outcomes and that, on appearance, poor quality tendon has adequate healing capacity. Therefore, abnormal gross tendon appearance should not affect the repair effort or technique.

No abstract

No abstract

Objectives:Numerous studies have identified risk factors which may decrease the chance of successful rotator cuff healing after surgery. Surgeons may also rely on intraoperative tendon quality to predict healing. There is no data that correlates how the gross tendon morphology and the degree of tendonopathy may impact patient outcome or post-operative tendon healing. The purposes of this study were to 1) compare the gross appearance of the supraspinatus tendon during arthroscopic rotator cuff repair with its histological degree of tendonopathy using the Bonar scoring system, and 2) to determine if either histological appearance or gross appearance correlated with Goutallier grade of fatty infiltration, or post-operative repair integrity. Our hypothesis was that there would be a statistical correlation between gross appearance and histological Bonar score, and that gross appearance would correlate with Goutallier grade and rate of healing.Methods:Demographic data from 105 patients undergoing (supraspinatus) rotator cuff repair were obtained. During surgery, the supraspinatus tendon was rated on thickness, fraying, and stiffness. Tendon tissue was also recovered for histological analysis based on the Bonar scoring system. Post-operative ASES and SST scores, as well as ultrasound assessment of healing, were obtained. Statistical analysis based on demographic data was carried out. Correlation between gross appearance of the supraspinatus tendon and rotator cuff histology (Bonar score) was determined. Correlation of gross appearance with Goutallier grade of fatty infiltration, and with post-operative repair integrity was also determined.Results:Gross appearance of torn rotator cuff tendon tissue did not correlate with histological appearance. Neither hisological score nor gross appearance correlated with demographic data, Goutallier grade, or post-operative repair status. Goutallier grade and vascularity were weakly correlated (rho=0.22, p=0.03)Conclusion:The degree of tendonopathy (Bonar Score) did not correlate with morphological appearance of the rotator cuff tendon, and neither of these parameters correlated with rotator cuff healing or patient outcome. Unlike fatty infiltration, or Goutallier scores, which evaluate the degree of muscle disease, this study suggests that the degree of tendonopathy may not be predictive of suboptimal outcomes. In light of these results, abnormal gross tendon appearance should not impact repair effort or technique.Figure 1:Frequency of total Bonar score among patient populationFigure 2:Hematoxylin and Eosin stained tissue (10x magnification)Table 1:Frequency and percentage rates of Gross Tendon CharacteristicsAt the time of surgery a full thickness tear of the supraspinatus was confirmed and AP size of tear was measured using a calibrated probe. The surgeon graded the gross appearance of the supraspinatus tendon using the following system: Thickness (normal, > 50%, < 50%), Fraying (none, fibrillations, delaminated), and Stiffness (not retracted, mobilizes with ease, recoils).Table 2:...

Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1–25.1) and a mean follow-up of 37.9 months (95% CI: 35.8–40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2–92.9] vs. 82.6 [95% CI: 79.0–86.2]; p < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5–0.8] vs. 1.2 [95% CI: 0.8–1.5]; p = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. Level of Evidence: case series, IV

Background Controlling pain after shoulder surgery is a critical component of postsurgical care. Several recent studies have described the use of periarticular, local infiltration anesthesia, and field blocks (FBs) with clinical efficacy after shoulder surgery. The anatomic accuracy and safety of these FBs have not been well described. The purpose of this study was to determine the accuracy of a surgeon performed shoulder field injection. We hypothesized that our field injection would adequately reach the pain transmitters responsible for postsurgical shoulder pain. Methods A total of 10 cadaveric specimens were used in the study. A mixture of liposomal bupivacaine, normal saline, and methylene blue totaling 60 cc was prepared. After injection, the specimens were left for 4 hours to allow medication diffusion. The dissection of specimens was performed to identify 4 areas: axillary nerve, suprascapular nerve, supraclavicular nerves, and joint capsule. On dissection, accuracy rates were determined for each area. Results All 10 cadaveric specimens were injected and dissected to completion. The dissection of the axillary nerve showed methylene blue dye surrounding the nerve in 10 of 10 (100%) specimens, the suprascapular nerve in 9 of 10 (90%), and the supraclavicular nerves in 10 of 10 (100%). Zero of 10 (0%) specimens had any dye penetrate into the glenohumeral joint or capsule. Conclusion The accuracy rates of the injection of the mixture into the shoulder specimens suggest potential to reproduce an FB to the tissues that are responsible for postoperative pain after shoulder surgery. This may represent an option when interscalene nerve block is not desired or contraindicated.