Supraspinatus Muscle and Tendon Stiffness Changes After Arthroscopic Rotator Cuff Repair: A Shear Wave Elastography Assessment

Abstract

Re‐tearing after arthroscopic rotator cuff repair (ARCR) frequently occurs, and high stiffness of the rotator cuff may be one of the factors. We investigated changes in stiffness of the supraspinatus muscle and tendon after ARCR as measured by shear wave elastography (SWE) with B‐mode ultrasound, and compared the supraspinatus muscle stiffness of patients with recurrent tears and patients with healed rotator cuffs. Sixty patients with supraspinatus tears requiring ARCR underwent serial SWE of their supraspinatus muscles and repaired tendons. SWE was performed before surgery (Pre‐Op) and at 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months after surgery. Additionally, the repaired rotator cuffs were evaluated using magnetic resonance imaging at 6 months after surgery to classify patients into a healed rotator cuff group and a recurrent tear group. Differences in SWE values between the groups were assessed at each time point. The SWE value of the repaired tendon at 1 week after ARCR was significantly greater than at 3 and 6 months. The SWE value for the supraspinatus muscle at 1 month after ARCR surgery in the healed group was lower than at Pre‐Op and 4, 5, and 6 months after surgery, and it was also lower than that at 1 month after surgery in the re‐tear group. There were no significant differences between time points in the SWE values of the supraspinatus muscle in the re‐tear group. The SWE value of the muscle in the re‐tear group was greater than in the healed group at 1 month after surgery (p < 0.05). Increased SWE values at 1 month after ARCR may predict recurrent rotator cuff tears after surgery rather than evaluating the tendon. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:219–227, 2020

Association of Recurrent Tear After Arthroscopic Rotator Cuff Repair and Superoxide-Induced Oxidative Stress

“…13,14,16,17 As a result, excessive passive tension is required to mobilize torn tendons to their insertion sites during ARCR, 4,21,44,49 which can increase the risk of retear. 15,22,46 These are probably the reasons that tear size was correlated with retear.…”

“…53 Fourth, the follow-up period of this study was short. However, almost all retears occurred \6 months after ARCR, 20,22,25,35 so it is sufficient to evaluate retears at 6 months after surgery.…”

“…However, recurrent tears after surgery remain a significant clinical problem, and recent studies have reported that recurrent tears occur in 10% to 90% of ARCR cases. 3,22,23,26,35 The patient's age, tear size, fatty infiltration, and stiffness in the rotator cuff muscle are all involved in the recurrence of tears after rotator cuff repair or failure of the initial repair to heal, 54 which typically occurs within 6 months after surgery. 20,22,25,35 Additionally, the high recurrent tear rate may be due to degenerative changes of the torn rotator cuff tendon.…”

“…3,22,23,26,35 The patient's age, tear size, fatty infiltration, and stiffness in the rotator cuff muscle are all involved in the recurrence of tears after rotator cuff repair or failure of the initial repair to heal, 54 which typically occurs within 6 months after surgery. 20,22,25,35 Additionally, the high recurrent tear rate may be due to degenerative changes of the torn rotator cuff tendon. 2,31,32,43 Oxidative stress is defined as a state of imbalance between oxidation and reduction reactions and is a biologic process that is implicated in the tendon degeneration process.…”

Discovery to delivery in tendon research

“…In vitro models are used to examine how dexamethasone can protect the tendon from degeneration, the roles of substrate stiffness and pulsed electromagnetic fields in tendon responses to inflammation, and tendon responses to mechanical loading . Finally, a series of papers examines the risk factors and susceptibility for rotator cuff disease and injury and the use of imaging modalities to assess changes to the cuff after repair . This special issue demonstrates exciting progress in the field towards understanding tendon pathogenesis and healing and presents a number of novel strategies to prevent disease progression and improve healing.…”