A Systematic Temporal Assessment of Changes in Tendon Stiffness Following Rotator Cuff Repair

Abstract

Objectives-How the material properties of the human supraspinatus tendon change following arthroscopic rotator cuff repair is undetermined. Shear wave elastography ultrasound is a relatively new, noninvasive measure of tissue stiffness. We aimed to evaluate any temporal changes in stiffness and/or thickness of supraspinatus tendons in humans following primary arthroscopic rotator cuff repair.Methods-Shear wave elastography was performed at three predetermined regions by a single sonographer at 1-, 6-, 12-, 24-, and 52 weeks postoperatively in 50 consecutive single-row inverted mattress primary arthroscopic rotator cuff repairs. One-way ANOVA with Tukey's correction and Spearman's correlation tests was performed.Results-Of 50 patients, two retore by 1-week and were excluded. Two patients retore at 6 weeks, two at 12 weeks, and one at 24 weeks. The mean tendon stiffness in 48 patients at the tendon footprint increased by 21% (1.32 m/s) at 6 months (P < .001), with the lateral tendon stiffening before the medial tendon. Tendon thickness decreased by 11% (0.6 mm) at 6 weeks (P = .008), then stabilized to 24 weeks. Tendons that were less elastographically stiff at 1 week were more likely to be thinner at 6-weeks (r = .38, P = .010).Conclusions-The data supports the hypothesis that rotator cuff tendons repaired using the single-row inverted-mattress technique take 6 weeks to heal to bone. Unlike in other tendons, there was no hypertrophic healing response. Prior to 6 weeks, the tendon may stretch/thin-out, particularly if its material properties, as assessed by shear wave elastography, are inferior. The material properties of the tendon improved at the tendon insertion site first, then medially out to 12 months post-repair.

Revision Rotator Cuff Repair With Versus Without an Arthroscopically Inserted Onlay Bioinductive Implant in Workers’ Compensation Patients

“…15 Another study performed at our institution found that the stiffness of supraspinatus tendons repaired without patches increased by 21% from 1 week to 6 months postoperatively (P < .001) and stabilized out to 12 months postoperatively. 9 However, the SWE stiffness of the tendon in this study remained unchanged at 6 m/s-which is lower than the average of 8 m/s in tendinopathic tendons-and 10 m/s in healthy tendons. 8 We did not identify any differences in patient-rated or surgeon-measured outcomes between patients with workers' compensation approval for revision rotator cuff repair who received a bioinductive implant versus those who did not at 6 months postoperatively.…”

“…6,11,16,20 Ultrasound Assessment All assessments of rotator cuff repair integrity and SWE stiffness of the supraspinatus tendon were performed on an ultrasound system with virtual touch imaging quantification elastography (Siemens Acuson S3000 HELIX Evolution ultrasound system with Virtual Touch IQ; Siemens Medical Solutions) with a linear 9L4 MHz transducer, per previously validated protocols. 4,9,21 A single sonographer (L.H.) with 25 years of experience in shoulder ultrasound performed all assessments.…”

The Fate of the Shoulder Post Rotator Cuff Repair: Biomechanical Properties of the Supraspinatus Tendon and Surrounding Structures

“…The SWE values of the stiffness of the healing rotator cuff tendon presented in our study may help guide clinical practice, especially postoperative patient rehabilitation. This study demonstrated that the repaired supraspinatus tendon 21 Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.…”

“…The strength of this present study was that all patients were prospectively recruited and assessed in a systematic fashion. All patients were treated by a single surgeon, using a single-row arthroscopic rotator cuff repair technique, and assessed by a single musculoskeletal sonographer, each with over 25 years of experience in arthroscopic shoulder surgery and shoulder ultrasound respectively, improving the internal 21 Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.…”

“…n = 48; *P < 0.05 using one-way repeated measures ANOVA with Tukey's correction for multiple comparisons. Modified from Hackett et al21 Adaptations are themselves works protected by copyright. So in order to publish this adaptation, authorization must be obtained both from the owner of the copyright in the original work and from the owner of copyright in the translation or adaptation.…”