Korean J Radiol.  2015 Apr;16(2):363-371. 10.3348/kjr.2015.16.2.363.

Repaired Supraspinatus Tendons in Clinically Improving Patients: Early Postoperative Findings and Interval Changes on MRI

• Lee JE
• Park JS
• Ryu KN
• Rhee YG
• Yoon SH
• Park SY
• Jin W

• KMID: 2070181
• DOI: http://doi.org/10.3348/kjr.2015.16.2.363

Abstract

OBJECTIVE
To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs.
MATERIALS AND METHODS
Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated.
RESULTS
The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050).
CONCLUSION
Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

Keyword

Supraspinatus; Postoperative; MRI; Healing; Retear

MeSH Terms

Adult
Aged
Female
Humans
*Magnetic Resonance Imaging
Male
Middle Aged
Postoperative Care
Rotator Cuff/pathology/*radiography/*surgery
Wound Healing

Figure

• 

  Fig. 1 Signal intensity (SI) patterns of repaired tendons on oblique coronal T2-weighted images. A. Type I tendon (heterogeneously high SI with fluid-like bright high SI foci) (arrow). B. Type II tendon (heterogeneously high SI without fluid-like bright high SI foci). C. Type III tendon (heterogeneously or homogeneously low SI).

• 

  Fig. 2 65-year-old man with repaired tendon that changed from type I to type II during follow-up period. A. Supraspinatus tendon was type I pattern 4 months after surgery, including fluid-like bright high signal intensity (SI) foci on contiguous oblique coronal T2-weighted images. Linear or curvilinear structures with intermediate to low SI, which appeared to be suture material, are detected within high SI area at repair site (thin arrows). B. Previous fluid-like bright high SI focus is replaced by low SI striations (thick arrows) 8 months after surgery, and tendon shows heterogeneously high SI without fluid-like bright high SI, consistent with type II pattern.

• 

  Fig. 3 55-year-old woman with repaired tendon that changed from type I to type III during follow-up period. A. Supraspinatus tendon shows type I pattern with fluid-like bright high signal intensity (SI) foci (thick arrow) on oblique coronal T2-weighted images 5 months after surgery. Linear or curvilinear structures with intermediate to low SI, which appeared to be suture material, are detected within high SI area at repair site (thin arrows). B. Tendon shows type III pattern with homogeneously low SI 11 months after surgery.

• 

  Fig. 4 64-year-old man with repaired tendon that changed from type II to type III during follow-up period. A. Supraspinatus tendon shows type II pattern with heterogeneously high signal intensity (SI) (arrow) on oblique coronal T2-weighted image 4 months after surgery. B. Tendon shows type III pattern with decreases in both SI and thickness (arrow) 12 months after surgery.

• 

  Fig. 5 52-year-old man with repaired tendon that changed from type I to type II during follow-up period, with decreased subacromial fluid and edema of rotator cuff interval. A, B. Serial oblique coronal T2-weighted images show thin supraspinatus tendon (double-headed arrow), and fluid SI of tendon disappears on second follow-up magnetic resonance image (MRI) (B) taken 6 months after first (A). C, D. Oblique sagittal images of first (C) and second (D) follow-up MRIs. Subacromial fluid (arrow in C) resolved, and thickness of rotator cuff interval (★ in C, D) decreased markedly.

• 

  Fig. 6 Distribution of signal intensity (SI) patterns on 100 postoperative magnetic resonance image based on follow-up period.

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