Vascularity of the supraspinatus tendon three months after repair: Characterization using contrast-enhanced ultrasound

Gamradt, Seth C.; Gallo, Robert A.; Adler, Ronald S.; Maderazo, Alex; Altchek, David W.; Warren, Russell F.; Fealy, Stephen

doi:10.1016/j.jse.2009.04.004

Cited by 63 publications

(48 citation statements)

References 17 publications

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“…[10][11][12] Although this method is useful for assessing the wash-in/wash-out kinetics, peak amplitude analysis does not produce a true topographic map of the distribution of vascularity within the rotator cuff. Maximum intensity projection imaging alternatively provides a spatial map of the temporal history of contrast enhancement during a prespecified time window.…”

Section: Discussionmentioning

confidence: 99%

“…A detailed summary of the patient demographics and sonographic techniques used was given by Gamradt et al 12 We briefly review the patient demographics from this study and the sonographic techniques used to acquire the contrast data. A subset of this patient cohort formed the study group for the data presented herein.…”

Section: Methodsmentioning

confidence: 99%

“…5 Methods to image the rotator cuff in vivo include magnetic resonance imaging and sonography, but methods to look specifically at the microcirculation have been limited. [3][4][5][6][7][8][9][10][11][12] To date, there has been limited in vivo assessment of vascularity after supraspinatus repair to determine the extent to which blood flow contributes to healing. A recent study using orthogonal polarization microscopy at arthroscopy found a statistically significant decrease in microcirculation adjacent to rotator cuff lesions.…”

mentioning

confidence: 99%

“…12 We sought to produce topographic maps of vascularity of those patients with intact supraspinatus tendon repairs, using a maximum intensity projection technique, to depict the regional distribution of enhancement after sonographic contrast agent administration. We tested the hypotheses that (1) contrast-enhanced sonography displayed as a maximum intensity projection image can depict regional variations in the vascularity of the repaired supraspinatus tendon; and (2) the distribution of enhancement increases after limited exercise.…”

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confidence: 99%

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Contrast-Enhanced Sonographic Characterization of the Vascularity of the Repaired Rotator Cuff

Adler

Johnson

Fealy

et al. 2011

Journal of Ultrasound in Medicine

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Objectives To characterize the distribution of vascularity of the postoperative rotator cuff tendon using a maximum intensity projection technique after contrast‐enhanced sonography. Methods We retrospectively evaluated image data on 23 patients (11 male and 12 female) with intact rotator cuff repairs who had previously undergone contrast‐enhanced sonography of their shoulders using lipid microspheres before and after a standardized exercise protocol. The patients were on average 3 months out from their surgery. Using offline image analysis software, a maximum intensity projection image was obtained for each patient, reflecting the regional vascular distribution within the repair and adjacent soft tissue. Subjective analysis was performed in 4 regions of interest: peribursal, articular medial, articular lateral, and suture anchor, independently by 2 musculoskeletal radiologists using a semiquantitative scale ranging from 0 to 4 for each region (0, no enhancement; 1, 1%–25% enhancement; 2, 26%–50%; 3, 51%–75%; and 4, 76%–100%). A combined vascularity score (0–8) was produced for each region and formed the basis for the subjective analysis. Results Using a Mann‐Whitney nonparametric test, the data showed significantly higher regional enhancement in the peribursal and suture anchor regions compared to the tendon (P < .001). Exercise resulted in a statistically significant increase in the extent of enhancement in all regions (P < .002). Inter‐rater reliability analysis using a weighted κ statistic showed strong agreement (0.63–0.64) for the suture anchor site and moderate agreement for the others (peribursal, 0.35–0.39; articular medial, 0.45–0.55; and articular lateral 0.32–0.33). Conclusions The maximum intensity projection technique after contrast‐enhanced sonography provides a topographic map of rotator cuff vascularity; the latter has been implicated as an important factor in promoting bone‐tendon healing. Approximately 3 months after rotator cuff repair, the suture anchor and peribursal regions showed the most robust vascularity. Maximum intensity projection imaging further establishes that there is a global increase in vascular response at the repair site after exercise.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Contrast-Enhanced Sonographic Characterization of the Vascularity of the Repaired Rotator Cuff

Adler

Johnson

Fealy

et al. 2011

Journal of Ultrasound in Medicine

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“…Multiple factors are thought to influence healing after cuff repair, including initial fixation strength [10], tendonfootprint contact area and pressure [4,32,34,35,44], tendon-footprint interface motion [1], tendon and bone tissue quality [19,43], synovial fluid extravasation [2], and blood supply to the repair [15]. Development of an appropriate animal model could help in elucidating the relationship between these variables and healing.…”

Section: Introductionmentioning

confidence: 99%

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Otarodifard

Wong

Preston

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Recent evidence suggests that the rabbit subscapularis tendon may be anatomically, biomechanically, and histologically suitable to study rotator cuff pathology and repair. However, biomechanical comparisons of rotator cuff repairs in this model have not been evaluated and compared to those in human cadaveric specimens. Questions/purposes We quantified the biomechanical properties of the repaired rabbit subscapularis tendon after (1) single-row, (2) double-row, and (3) transosseousequivalent rotator cuff repair techniques and compared the ratios of repairs to previously published data for human repairs.Methods Tensile testing was performed on 21 New Zealand White rabbit subscapularis tendon-humerus complexes for single-row repair, double-row repair, and transosseous-equivalent repair (n = 7 for each group). Video digitizing software was used to quantify deformation. Load elongation data were then used to quantify structural properties. We compared the ratios of rotator cuff repairs for the rabbit data to data from human supraspinatus repair studies previously performed in our laboratory. For our primary end points (linear stiffness, yield load, ultimate load, and energy absorbed to failure), with the numbers available, our statistical power to detect a clinically important difference (defined as 15%) was 85%. Results The ratios of single-row/double-row repair were 0.72, 0.73, 0.71, and 0.66 for human supraspinatus and 0.77, 0.74, 0.79, and 0.89 for rabbit subscapularis repair for linear stiffness, yield load, ultimate load, and energy absorbed to failure, respectively. The ratios of double-row/transosseousequivalent repair were 1.0, 0.86, 0.70, and 0.41 for human supraspinatus and 1.22, 0.85, 0.76, and 0.60 for rabbit subscapularis for linear stiffness, yield load, ultimate load, and energy absorbed to failure, respectively. There were no differences comparing rabbit to human repair ratios for any parameter (p [ 0.09 for all comparisons). Conclusions Subscapularis repairs in the rabbit at Time 0 result in comparable ratios to human supraspinatus repairs. Clinical Relevance The biomechanical similarities between the different types of rotator cuff repair in the rabbit subscapularis and human supraspinatus at Time 0 provide more evidence that the rabbit subscapularis may be an appropriate model to study rotator cuff repairs.

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Pathophysiology of Rotator Cuff Tears

Scott

Khan

Petrigliano

2014

Massive Rotator Cuff Tears

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Vascularity of the supraspinatus tendon three months after repair: Characterization using contrast-enhanced ultrasound

Cited by 63 publications

References 17 publications

Contrast-Enhanced Sonographic Characterization of the Vascularity of the Repaired Rotator Cuff

Contrast-Enhanced Sonographic Characterization of the Vascularity of the Repaired Rotator Cuff

Relative Fixation Strength of Rabbit Subscapularis Repair Is Comparable to Human Supraspinatus Repair at Time 0

Pathophysiology of Rotator Cuff Tears

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