Grade of retraction and tendon thickness correlates with MR-spectroscopically measured amount of fatty degeneration in full thickness supraspinatus tears

Abstract

BackgroundThe amount of fatty degeneration (FD) has major impact on the clinical result and cuff integrity after rotator cuff repair. A quantitative analysis with magnet resonance imaging (MRI) spectroscopy was employed to analyze possible correlation of FD with tendon retraction, tendon thickness and patients’ characteristics in full thickness supraspinatus tears.MethodsForty-two patients with full-thickness supraspinatus tears underwent shoulder MRI including an experimental spectroscopic sequence allowing quantification of the fat fraction in the supraspinatus muscle belly. The amount of fatty degeneration was correlated with tendon retraction, tendon thickness, patients’ age, gender, smoker status, symptom duration and body mass index (BMI). Patients were divided in to three groups of retraction (A) 0-10 mm (n=), (B) 11-20 mm (n=) and (C) < 21 mm (n=) and the means of FD for each group were calculated.ResultsTendon retraction (R = 0.6) and symptom duration (R = 0.6) correlated positively, whereas tendon thickness correlated negatively (R = − 0.6) with the amount of FD. The fat fraction increased significantly with tendon retraction: Group (A) showed a mean fat mount of 3.7% (±4%), group (B) of 16.7% (±8.2%) and group (C) of 37.5% (±19%). BMI, age and smoker-status only showed weak to moderate correlation with the amount of FD in this cohort.ConclusionMRI spectroscopy revealed significantly higher amount of fat with increasing grade of retraction, symptom duration and decreased tendon thickness. Thus, these parameters may indirectly be associated with the severity of tendon disease.

Ultrasound shear wave elastography and its association with rotator cuff tear characteristics

“…Consequently, the relationship between the estimated shear modulus and any individual tear characteristic or chronicity variable is likely confounded if coexisting variables have opposing influences on SWE measurements. For example, a supraspinatus muscle with a high degree of fatty degeneration (which often occurs in larger and more chronic rotator cuff tears 18 , 30 ) would be expected to have a lower estimated shear modulus than a healthy rotator cuff because fat presumably has a lower SWE measurement than muscle. However, a chronic rotator cuff tear may be stiffer due to tendon retraction and fibrosis, 16 , 20 , 26 , 47 , 48 thus resulting in a higher SWE measurement.…”

Radiographic greater tuberosity spurs and narrow acromiohumeral intervals are associated with advanced retraction of the supraspinatus tendon in patients with symptomatic rotator cuff tears

“… 17 The combination of concomitant severe fatty infiltration of infraspinatus muscles and severe retraction of the supraspinatus tendon has been shown to be a highly specific predictor of irreparability of a rotator cuff tear. 14 In addition, the degree of fatty infiltration correlates positively with the stage of retraction, 10 which has been reported to equate negatively to postoperative function. 8 , 11 Therefore, some authors have advocated early diagnosis and early intervention of rotator cuff tears, lest patients become susceptible to incomplete repairs after the degenerative rotator cuff cascade is initiated.…”

“…Patients whose preoperative magnetic resonance imaging (MRI) reveals concomitant supraspinatus retraction and fatty infiltration have been found to have a 92% rotator cuff repair failure rate, 17 whereas absence of these degenerative changes is an indicator of repairable massive rotator cuff tears with a 96% specificity. 14 The more advanced the supraspinatus retraction is, the more severe the supraspinatus muscle atrophy 9 and fatty infiltration 10 are. To our knowledge, the relation between radiographic degenerative signs and supraspinatus tendon retraction has not been elucidated.…”

Factors associated with needle breakage of antegrade suture passer and effect of intratendinous remnant needle tip on clinical outcomes after arthroscopic rotator cuff repair

“…2). 14 In cases of delaminated tears, the vertical width of bursal and articular side delaminated tendons were measured at each and added numerically. In addition, the tendinosis grade was evaluated by the tendinosis grading system suggested by Sein et al 15 : grade 0 is a tendon with complete homogeneous low intensity on all pulse sequences, grade 1 is a mild focal increase in tendon signal (mild tendinosis) on proton density (PD) and fat-suppressed (FS) T2 sequencing not equal to that of fluid, grade 2 is a moderate focal increase in tendon signal (moderate tendinosis) on PD and FS T2 sequencing not equal to that of fluid, and grade 3 is a marked generalized increase in tendon signal (marked tendinosis) without frank fluid signal intensity, which could be applied to the rotator cuff tear patients in same manner according to the study of Chung et al 16 .…”