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Surgically Repaired Massive Rotator Cuff Tears: MRI of Tendon Integrity, Muscle Fatty Degeneration, and Muscle Atrophy Correlated with Intraoperative and Clinical Findings

J. M. Mellado1, J. Calmet2, M. Olona3, C. Esteve2, A. Camins1, L. Pérez del Palomar4, J. Giné2 and A. Saurí1

1 Institut de Diagnòstic per la Imatge, Hospital Universitari de Tarragona Joan XXIII, Carrer Doctor Mallafrè Guasch, 4, 43007-Tarragona, Spain.
2 Servei de Cirurgia Ortopèdica i Traumatologia, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
3 Servei de Medicina Preventiva i Epidemiologia, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
4 Servei de Radiologia, Pius Hospital de Valls, Tarragona, Spain.



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  		Fig. 1A. —Cross-sectional schematics of rotator cuff. Scheme of most lateral oblique sagittal MR image in which scapular spine is seen in contact with scapular body (Y-shaped view) showing cross-sectional contour of supraspinatus (SS), infraspinatus (IS), and subscapularis (SB) muscles for evaluation of muscle fatty degeneration.

 


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  		Fig. 1B. —Cross-sectional schematics of rotator cuff. For evaluation of muscle atrophy, measurement of cross-sectional areas of supraspinatus (SS), infraspinatusteres minor (IS, TM), and subscapularis (SB) muscles is performed.

 


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  		Fig. 1C. —Cross-sectional schematics of rotator cuff. To compensate for individual body constitution, standardized areas were calculated by dividing areas of rotator cuff muscle bellies by area of supraspinatus fossa (F).

 


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  		Fig. 1D. —Cross-sectional schematics of rotator cuff. Muscle atrophy of supraspinatus (SS) muscle also is evaluated by using tangent sign, which is considered negative when superior border of supraspinatus is superior to line tangential to coracoid and scapular spine (arrow).

 


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  		Fig. 2A. —Postoperative oblique coronal STIR images of massive RCT repair in two different patients. Oblique coronal STIR image of right shoulder in 56-year-old man after complete repair of massive RCT shows tendinous integrity (postoperative UCLA score reached 29 points).

 


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  		Fig. 2B. —Postoperative oblique coronal STIR images of massive RCT repair in two different patients. Oblique coronal STIR image of right shoulder in 73-year-old man after complete repair of massive RCT shows wide rerupture (postoperative UCLA score reached 35 points).

 


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  		Fig. 3A. —Oblique sagittal MRIs of 64-year-old man before and after massive RCT repair. Oblique sagittal T2-weighted MRI of right shoulder before repair of massive RCT (preoperative UCLA score reached 10 points) shows atrophy and fatty degeneration of supraspinatus (stage 1) and infraspinatus (stage 3) muscles.

 


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  		Fig. 3B. —Oblique sagittal MRIs of 64-year-old man before and after massive RCT repair. Oblique sagittal T1-weighted MRI of right shoulder after incomplete repair of massive RCT (postoperative UCLA score reached 29 points) shows progression of atrophy and fatty degeneration of supraspinatus (stage 4) and infraspinatus (stage 4) muscles.

 


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  		Fig. 4A. —Postoperative oblique sagittal T1-weighted MRIs in two different patients. Oblique sagittal T1-weighted MRI of the right shoulder in 69-year-old man after incomplete repair of massive RCT (postoperative UCLA score reached 30 points) shows severe atrophy and fatty degeneration of supraspinatus (stage 3) and infraspinatus (stage 4) muscles.

 


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  		Fig. 4B. —Postoperative oblique sagittal T1-weighted MRIs in two different patients. Oblique sagittal T1-weighted MRI image of the left shoulder in 73-year-old man after complete repair of massive RCT (postoperative UCLA score reached 15 points) shows severe atrophy and fatty degeneration of supraspinatus, infraspinatus, and subscapularis muscles (stage 4).

 

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