MRI of Superior Capsular Reconstruction

Abstract

Massive irreparable rotator cuff tears can be a challenging problem for arthroscopists in the perioperative setting because the typical treatment, reverse total shoulder arthroplasty, may not be the best option for all patients. Superior capsular reconstruction (SCR) is an advancing treatment option for patients with rotator cuff tears that are neither amenable to primary repair nor ideal for arthroplasty. Patient selection, which is strongly dependent on preoperative imaging findings, is an important step in obtaining favorable surgical outcomes. The tissue quality and tear type are particularly important when considering SCR for a patient. When unsuccessful SCR is suspected, postoperative MRI of the shoulder offers the surgeon and radiologist a means of evaluating the integrity and fixation of the graft. Fluid-sensitive MRI sequences are best for examining the final SCR construct, with high-signal-intensity fluid interruptions within the graft and the presence or worsening of shoulder arthropathy indicating graft failure. The indications for SCR are discussed, and the normal postoperative MRI findings after SCR are described in this review. In addition, the common types of SCR graft failure and associated imaging findings are described and illustrated.© RSNA, 2020 • radiographics.rsna.org

Arthroscopic superior capsular reconstruction versus reverse shoulder arthroplasty in patients with massive irreparable rotator cuff tears: A comparative clinical study

“…Postoperative MRI evaluation was performed for all patients in the aSCR group at last follow-up visit in order to evaluate graft healing. 15 …”

Posttreatment Imaging of the Shoulder

“…On postoperative MR imaging, the transplant can be identified as a low signal intensity structure lying taut directly above the humeral head, which should be centered in the glenoid. 26 The graft should have a minimum thickness of 3 mm. 27 Superior migration of the humeral head up to 5 mm in relation to the upper rim of the glenoid may be within normal margins, but migration > 10 mm may indicate graft failure.…”

“…Any detachment, discontinuity, or displacement of the graft are basic imaging findings of failed SCR. 26 Typical tears are at the adaptation to the anterior infraspinatus tendon, at the midsubstance, or at the humeral or glenoid fixation. 26 In patients with complex defects, displacement of the graft may also be recognized.…”

Patients With Intact Shoulder Superior Capsular Reconstruction Grafts on Ultrasound Show Significant Improvement in Functional Outcomes at Minimum 2-Year Follow-up

“… 11 , 12 , 23 , 24 The typically preferred method for evaluating SCR postoperatively is magnetic resonance imaging (MRI). 25 However, ultrasound can be a less expensive and more readily available imaging modality to assess graft integrity after SCR.…”