Advertisement

Diagnostic Ultrasound Shows Reversal of Supraspinatus Muscle Atrophy Following Arthroscopic Rotator Cuff Repair

      Purpose

      Prospective study to assess ultrasonography (US) utility as an imaging tool for supraspinatus muscle atrophy diagnosis, establishing if there is any relationship between repairing supraspinatus tears and its eventual muscular recovery.

      Methods

      Observational study. Selection criteria: adults with a full-thickness reparable supraspinatus tear confirmed arthroscopically. Clinical and imaging data pre- and postoperatively with 12 months of follow-up were recorded, including demographic data, Constant scale, Patte classification, repair type, and supraspinatus muscle belly US images in both shoulders, recording height, diameter, echogenicity (mean number of pixels between 0-black and 255-white), and central tendon pennate angle (PA).

      Results

      In total, 110 supraspinatus tears underwent arthroscopic repair (2015-2018). Mean age was 61 ± 8 years (46-77). We detected a correlation between atrophy and age in terms of echogenicity and PA (P = .01). Echogenicity improved from 54.5 to 51.0 (P = .365) and slightly deteriorated on the contralateral side from 51.6 to 52.9 (P = .351). Supraspinatus echogenicity compared to trapezius muscle reduced from 0.43 to 0.36 (P < .001). PA augmented from 5.8 to 8.6 (P < .001). Mean PA on the contralateral side was 8.6 preoperatively. Patte II cases showed the most significant improvement in terms of imaging evaluation of atrophy. Although Patte III cases almost did not improve in terms of atrophy, they improved clinically. We observed improvement after surgery in Constant score from 35 to 85 (P < .001). Minimal clinically important differences for Constant and visual analog scale were 44.45 ± 12.87 and 6.54 ± 1.41, respectively. Recurrence of symptoms was 13%, related to worse results of PA and echogenicity compared to nonrecurrences.

      Conclusions

      Supraspinatus atrophic muscle changes after repair can be reversed. It can be quantified using US imaging (histogram, histogram ratio and echogenicity reduction, pennate pattern, and PA augmentation). Patte II cases showed the best results after repair, demonstrated by US. The faster the repair, the better the results without being influenced by repair type. The bigger the tear and retraction, the more echogenicity and less PA, with worse clinical and US results.

      Level of Evidence

      Level III, prospective therapeutic study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Doherty T.J.
        Aging and sarcopenia.
        J Appl Physiol. 2003; 95: 1717-1727
        • Chung S.W.
        • Yoon J.P.
        • Oh K.S.
        • et al.
        Rotator cuff tear and sarcopenia: are these related?.
        J Shoulder Elbow Surg. 2016; 25: 249-255
        • Yin H.
        • Price F.
        • Rudnicki M.A.
        Satellite cells and the muscle stem cell niche.
        Physiol Rev. 2013; 93: 23-67
        • Goutallier D.
        • Postel J.M.
        • Bernageau J.
        • Lavau L.
        • Voisin M.C.
        Fatty muscle degeneration in cuff ruptures pre- and postoperative evaluation by CT scan.
        Clin Orthop Relat Res. 1994; 304: 78-83
        • Meyer D.C.
        • Hoppeler H.
        • von Rechenberg B.
        • Gerber C.
        A pathomechanical concept explains muscle loss and fatty muscular changes following surgical tendon release.
        J Orthop Res. 2004; 22: 1004-1007
        • 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.
        Am J Sports Med. 2007; 35: 719-728
        • Goutallier D.
        • Postel J.M.
        • Gleyze P.
        • Leguilloux P.
        • Van Driessche S.
        Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full thickness tears.
        J Shoulder Elbow Surg. 2003; 12: 550-554
        • Melis B.
        • De Franco M.J.
        • Chuinard C.
        • Walch G.
        Natural history of fatty infiltration and atrophy of the supraspinatus muscle in rotator cuff tears.
        Clin Orthop Relat Res. 2010; 468: 1498-1505
        • 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.
        J Bone Joint Surg Am. 2006; 88: 309-316
        • Liem D.
        • Lichtenberg S.
        • Magosch P.
        • Habermeyer P.
        Magnetic resonance imaging of arthroscopic supraspinatus tendon repair.
        J Bone Joint Surg Am. 2007; 89: 1770-1776
        • Mellado J.M.
        • Calmet J.
        • Olona M.
        • et al.
        Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings.
        AJR Am J Roentgenol. 2005; 184 (1456-146)
        • Gerber C.
        • Fuchs B.
        • Hodler J.
        The results of repair of massive tears of the rotator cuff.
        J Bone Joint Surg Am. 2000; 82: 505-515
        • Bjoerkenheim J.
        Structure and function of the rabbit’s supraspinatus muscle after resection of its tendon.
        Acta Orthop Scand. 1989; 60: 461-463
        • Nakagaki K.
        • Ozaki J.
        • Tomita Y.
        • Tamai S.
        Alterations in the supraspinatus muscle belly with rotator cuff tearing: Evaluation with magnetic resonance imaging.
        J Shoulder Elbow Surg. 1994; 3: 88-93
        • Burkhart S.S.
        • Barth J.R.
        • Richards D.P.
        • Zlatkin M.B.
        • Larsen M.
        Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration.
        Arthroscopy. 2007; 23: 347-354
        • Lorbach O.
        • Baums M.H.
        • Kostuj T.
        • et al.
        Advances in biology and mechanics of rotator cuff repair.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 530-541
        • Oh J.H.
        • Kim S.H.
        • Ji H.M.
        • Jo K.H.
        • Bin S.W.
        • Gong H.S.
        Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome.
        Arthroscopy. 2009; 25: 30-39
        • Constant C.R.
        • Murley A.H.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop. 1987; 214: 160-164
        • Amstutz H.C.
        • Sew Hoy A.L.
        • Clarke I.C.
        UCLA anatomic total shoulder arthroplasty.
        Clin Orthop. 1981; 155: 10-14
        • Jost B.
        • Pfirrmann C.W.
        • Gerber C.
        • Switzerland Z.
        Clinical outcome after structural failure of rotator cuff repairs.
        J Bone Joint Surg Am. 2000; 82: 304-314
        • Thomazeau H.
        • Rolland Y.
        • Lucas C.
        • Duval J.M.
        • Langlais F.
        Atrophy of the supraspinatus belly: Assessment by MRI in 55 patients with rotator cuff pathology.
        Acta Orthop Scand. 1996; 67: 264-268
        • Wall L.B.
        • Teefey S.A.
        • Middleton W.D.
        • et al.
        Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles.
        J Bone Joint Surg Am. 2012; 94: e83
        • Chung S.W.
        • Kim S.H.
        • Tae S.K.
        Is the supraspinatus muscle atrophy truly irreversible after surgical repair of rotator cuff tears?.
        Clin Orthop Surg. 2013; 5: 55-65
        • Teefey S.A.
        Shoulder sonography: Why we do it.
        J Ultrasound Med. 2012; 31: 1325-1331
        • Park B.K.
        • Hong S.H.
        • Jeong W.K.
        Effectiveness of ultrasound in evaluation of fatty infiltration in rotator cuff muscles.
        Clin Orthop Surg. 2020; 12: 76-85
        • Apostolopoulos A.P.
        • Angelis S.
        • Yallapragada R.K.
        • et al.
        The sensitivity of magnetic resonance imaging and ultrasonography in detecting rotator cuff tears.
        Cureus. 2019; 11: 5
        • de Jesus J.O.
        • Parker L.
        • Frangos A.J.
        • Nazarian L.N.
        Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: A meta-analysis.
        AJR Am J Roentgenol. 2009; 192: 1701-1707
        • Okoroha K.R.
        • Mehran N.
        • Duncan J.
        • et al.
        Characterization of rotator cuff tears: ultrasound versus magnetic resonance imaging.
        Orthopedics. 2017; 40: 124-130
        • Sofka C.M.
        • Haddad Z.K.
        • Adler R.S.
        Detection of muscle atrophy on routine sonography of the shoulder.
        J Ultrasound Med. 2004; 23: 1031-1034
        • Strasser E.M.
        • Draskovits T.
        • Praschak M.
        Association between ultrasound measurements of muscle thickness, pennation angle, echogenicity and skeletal muscle strength in the elderly.
        AGE. 2013; 35: 2377-2388
        • Patte D.
        Classification of rotator cuff lesions.
        Clin Orthop Relat Res. 1990; 254: 81-86
        • Fuchs B.
        • Weishaupt D.
        • Zanetti M.
        • Hodler J.
        • Gerber C.
        Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging.
        J Shoulder Elbow Surg. 1999; 8: 599-605
        • Thomazeau H.
        • Boukobza E.
        • Morcet N.
        • Chaperon J.
        • Langlais F.
        Prediction of rotator cuff repair results by magnetic resonance imaging.
        Clin Orthop Relat Res. 1997; 344: 275-283
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Gerber Ch
        • Meyer D.
        • Frey E.
        • et al.
        Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction: An experimental study in sheep.
        J Shoulder Elbow Surg. 2009; 18: 163-171
        • Hamano N.
        • Yamamoto A.
        • Shitara H.
        • et al.
        Does successful rotator cuff repair improve muscle atrophy and fatty infiltration of the rotator cuff? A retrospective magnetic resonance imaging study performed shortly after surgery as a reference.
        J Shoulder Elbow Surg. 2017; 26: 967-974
        • Vidt M.E.
        • Santago II, A.C.
        • Tuohy C.J.
        • et al.
        Assessments of fatty infiltration and muscle atrophy from a single magnetic resonance image slice are not predictive of 3-dimensional measurements.
        Arthroscopy. 2016; 32: 128-139
        • Khanna R.
        • Saltzman M.D.
        • Elliott J.M.
        • et al.
        Development of 3D method to assess intramuscular spatial distribution of fat infiltration in patients with rotator cuff tear: reliability and concurrent validity.
        BMC Musculoskeletal Disord. 2019; 20: 295
        • Strobel K.
        • Hodler J.
        • Meyer D.C.
        • Pfirrmann C.W.
        • Pirkl C.
        • Zanetti M.
        Fatty atrophy of supraspinatus and infraspinatus muscles: accuracy of US.
        Radiology. 2005; 237: 584-589
        • Khoury V.
        • Cardinal E.
        • Brassard P.
        Atrophy and fatty infiltration of the supraspinatus muscle: sonography versus MRI.
        AJR Am J Roentgenol. 2008; 190: 1105-1111
        • Nozaki T.
        • Tasaki A.
        • Horiuchi S.
        • et al.
        Predicting retear after repair of full-thickness rotator cuff tear: two-point Dixon MR imaging quantification of fatty muscle degeneration—initial experience with 1-year follow-up.
        Radiology. 2016; 280: 500-509
        • Evancho A.M.
        • Stiles R.G.
        • Fajman W.A.
        • et al.
        MR imaging diagnosis of rotator cuff tears.
        AJR Am J Roentgenol. 1988; 151: 751-754
        • Iannotti J.P.
        • Zlatkin M.B.
        • Esterhai J.L.
        • Kressel H.Y.
        • Dalinka M.K.
        • Spindler K.P.
        Magnetic resonance imaging of the shoulder: Sensitivity, specificity, and predictive value.
        J Bone Joint Surg Am. 1991; 73: 17-29
        • Singson R.D.
        • Hoang T.
        • Dan S.
        • Friedman M.
        MR evaluation of rotator cuff pathology using T2-weighted fast spin-echo technique with and without fat suppression.
        AJR Am J Roentgenol. 1996; 166: 1061-1065
        • Roy J.S.
        • Braën C.
        • Leblond J.
        • et al.
        Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: A systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 1316-1328
        • Watanabe T.
        • Terabayashi N.
        • Fukuoka D.
        • et al.
        A pilot study to assess fatty infiltration of the supraspinatus in patients with rotator cuff tears: Comparison with magnetic resonance imaging.
        Ultrasound Med Biol. 2015; 41: 1779-1783
        • Kim Y.K.
        • Choi E.S.
        • Kim K.T.
        • Yoon J.R.
        • Chae S.H.
        Quantitative measurement of muscle atrophy and fat infiltration of the supraspinatus muscle using ultrasonography after arthroscopic rotator cuff repair.
        Ann Rehabil Med. 2018; 42: 260-269
        • Sachdeva R.
        • Beavis C.
        • Obaid H.
        • Farthing J.P.
        • Kim S.Y.
        Surgical repair of the supraspinatus: Architectural changes in the muscle pre- and postoperatively.
        Singapore Med J. 2020; 1: 26
        • Fischer C.
        • Gross S.
        • Zeifang F.
        • Schmidmaier G.
        • Weber M.A.
        • Kunz P.
        Contrast-enhanced ultrasound determines supraspinatus muscle atrophy after cuff repair and correlates to functional shoulder outcome.
        Am J Sports Med. 2018; 46: 2735-2742
        • Thompson S.M.
        • Reilly P.
        • Emery R.G.
        • Bull A.M.J.
        An anatomical description of the pennation angles and central tendon angle of the supraspinatus both in its normal configuration and with full thickness tears.
        J Shoulder Elbow Surg. 2011; 20: 899-903
        • Sasaki T.
        • Shitara H.
        • Yamamoto A.
        • et al.
        What is the appropriate reference for evaluating the recovery of supraspinatus muscle atrophy after arthroscopic rotator cuff repair? The occupation ratio of the supraspinatus may change after rotator cuff repair without volumetric improvement.
        Am J Sports Med. 2018; 46: 1416-1423