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Editorial Commentary: Muscle Atrophy After Arthroscopic Rotator Cuff Repair—Reversible?

      Abstract

      Muscle atrophy has been established as a predictor of failure after rotator cuff repair. Traditionally, preoperative magnetic resonance imaging has been used as a baseline for subsequent comparison. Use of a preoperative baseline may overestimate the degree of atrophy present. In addition, postoperative progression of atrophy correlates with the integrity of the tendon.
      Muscle atrophy associated with full-thickness rotator cuff tear has been associated with clinical outcome, functional recovery, and retear rates after repair.
      • Gerber C.
      • Fuchs B.
      • Hodler J.
      The results of repair of massive tears of the rotator cuff.
      • Thomazeau H.
      • Boukobza E.
      • Morcet N.
      • Chaperon J.
      • Langlais F.
      Prediction of rotator cuff repair results by magnetic resonance imaging.
      Generally, it is assumed that muscle atrophy is irreversible and may progress over time, even after repair.
      • Hata Y.
      • Saitoh S.
      • Murakami N.
      • Kobayashi H.
      • Kaito T.
      • Kato H.
      Volume changes of supraspinatus and infraspinatus muscles after supraspinatus tendon repair: A magnetic resonance imaging study.
      However, prior studies have used preoperative imaging as a baseline for comparison.
      • Gerber C.
      • Fuchs B.
      • Hodler J.
      The results of repair of massive tears of the rotator cuff.
      • Thomazeau H.
      • Boukobza E.
      • Morcet N.
      • Chaperon J.
      • Langlais F.
      Prediction of rotator cuff repair results by magnetic resonance imaging.
      • Hata Y.
      • Saitoh S.
      • Murakami N.
      • Kobayashi H.
      • Kaito T.
      • Kato H.
      Volume changes of supraspinatus and infraspinatus muscles after supraspinatus tendon repair: A magnetic resonance imaging study.
      • Fuchs B.
      • Gilbart M.K.
      • Hodler J.
      • Gerber C.
      Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff.
      • Gerber C.
      • Schneeberger A.G.
      • Hoppeler H.
      • Meyer D.C.
      Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: A study in thirteen patients.
      • Liem D.
      • Lichtenberg S.
      • Magosch P.
      • Habermeyer P.
      Magnetic resonance imaging of arthroscopic supraspinatus tendon repair.
      • Gladstone J.N.
      • Bishop J.Y.
      • Lo I.K.
      • Flatow E.L.
      Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome.
      • Gerber C.
      • Meyer D.C.
      • Frey E.
      • et al.
      Neer Award 2007: Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep.
      In the elegant study by Jo et al.,
      • Jo C.H.
      • Park J.W.
      • Shin J.S.
      Changes of muscle atrophy according to the immediate postoperative time point in magnetic resonance imaging after arthroscopic rotator cuff repair.
      the authors examined the effect of arthroscopic rotator cuff repair on rotator cuff muscle atrophy at various time points including preoperatively, immediately postoperatively, and 1 year postoperatively. The complexity and cost of following up these patients with serial imaging is significant, and the authors are to be commended on the completion of this study.
      The results of the study suggest that, in general, rotator cuff muscle atrophy improves after arthroscopic repair but that increased atrophy is seen 1 year postoperatively as compared with the immediate postoperative state. Although these results may seem counterintuitive, they do correlate with the results of previous work that suggests that tendon and muscle retraction may account for the appearance of atrophy on preoperative imaging.
      • Jo C.H.
      • Shin J.S.
      Changes in appearance of fatty infiltration and muscle atrophy of rotator cuff muscles on magnetic resonance imaging after rotator cuff repair: Establishing new time-zero traits.
      In addition, they suggest that the use of preoperative imaging may overestimate the degree of atrophy and may be inappropriate to use as a comparison to assess subsequent changes. The authors correctly show that immediate postoperative imaging is a more appropriate baseline to be used for comparison against subsequent change.
      As would be expected, muscle atrophy did in fact worsen over time, but more so in the group with failed repair.
      • Jo C.H.
      • Park J.W.
      • Shin J.S.
      Changes of muscle atrophy according to the immediate postoperative time point in magnetic resonance imaging after arthroscopic rotator cuff repair.
      The results of this study do highlight the importance of achieving structural integrity after rotator cuff repair in regard to functional recovery and prevention of progressive tear size and muscle deterioration over time.

      References

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        Prediction of rotator cuff repair results by magnetic resonance imaging.
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