Supraspinatus muscle location changes after arthroscopic rotator cuff repair: a potential source of preoperatively predicting tear patterns
Authors Ono Y, Makihara T, Yamashita S, Tam KKW, Kawai N, Lo IKY, Kimura A
Received 25 October 2018
Accepted for publication 23 January 2019
Published 1 March 2019 Volume 2019:10 Pages 33—39
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Andreas Imhoff
Yohei Ono,1 Takeshi Makihara,2 Satoshi Yamashita,3 Kelvin KW Tam,4 Nobuaki Kawai,1 Ian KY Lo,5 Akihiko Kimura1
1Department of Orthopaedic Surgery, East Hokkaido Hospital, Kushiro, Hokkaido, Japan; 2Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 3Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan; 4Asia Medical Specialists, Hong Kong, China; 5Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, NW, Calgary, AB, Canada
Purpose: When repairing retracted rotator cuff tears, the tear pattern (eg, crescent-shaped, L-shaped) is best determined intraoperatively by evaluating the mobility of the tendon in multiple directions. The purpose of our study was to evaluate the location of the supraspinatus (SSP) muscle belly on magnetic resonance imaging (MRI) in patients undergoing arthroscopic repair of retracted rotator cuff tears. We hypothesized that the location of the rotator cuff muscle would move after tendon repair, and that the perioperative change in muscle position would correlate with the tear pattern.
Methods: A series of primary arthroscopic repairs for rotator cuff tears with >3 cm of medial retraction from 2015 to 2016 was reviewed. MRIs were performed preoperatively and within 10 days postoperatively. The SSP muscle was assessed on sagittal MRI and evaluated for the “occupation ratio”, “tangent sign”, and the “location index” proposed in this study. Pre and postoperative MRIs were compared, and correlated with intraoperatively determined tear patterns. Fifty shoulders without rotator cuff pathology were also assessed for the “location index” as control.
Results: Fifty-nine shoulders (mean age 65.0 years) were included, among which five reverse L-shaped tears were identified. The occupation ratio and tangent sign improved postoperatively. Preoperatively, in the majority of tears, the SSP muscle was located more posteriorly in the SSP fossa, compared to the control group, and shifted anteriorly after repair. However, in reverse L-shaped tears the SSP muscle was located more centrally in the fossa, and shifted posteriorly following repair.
Conclusion: Rotator cuff tearing and arthroscopic rotator cuff repair change the location of the SSP muscle. Although repair usually results in shifting of the muscle belly from posterior to anterior, reverse L-shaped tears demonstrated an opposite pattern. The location of the SSP muscle belly may be useful in predicting tear patterns of retracted rotator cuff tears.
Level of evidence: Level IV (case series).
Keywords: shoulder, rotator cuff, muscle belly, muscle location, MRI, muscle atrophy, tendon retraction, location index
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