Clin Orthop Surg.  2014 Sep;6(3):336-342. 10.4055/cios.2014.6.3.336.

A Comparison of Conventional Ultrasonography and Arthrosonography in the Assessment of Cuff Integrity after Rotator Cuff Repair

• Lee KW
• Yang DS
• Chun TJ
• Bae KW
• Choy WS
• Park HJ

• KMID: 1794717
• DOI: http://doi.org/10.4055/cios.2014.6.3.336

Abstract

BACKGROUND
This study was designed to perform conventional ultrasonography, magnetic resonance arthrography (MRA) and arthrosonography exams after rotator cuff repair to compare the results of conventional ultrasonography and arthrosonography with those of MRA as the gold standard.
METHODS
We prospectively studied 42 consecutive patients (14 males, 28 females; average age, 59.4 years) who received arthroscopic rotator cuff repair due to full-thickness tears of the supraspinatus tendon from 2008 to 2010. The integrity assessment of the repaired rotator cuff was performed 6 months postoperatively using conventional ultrasonography, MRA, and arthrosonography.
RESULTS
The diagnostic accuracy of the conventional ultrasonography compared to MRA was 78.6% and the McNemar test results were 0.016 in full-thickness tear and 0.077 in partial-thickness tear. The diagnostic accuracy of arthrosonography compared to MRA was 92.9% and the McNemar test results were 0.998 in full-thickness tear and 0.875 in partial-thickness tear.
CONCLUSIONS
It was found that the integrity assessment of the repaired rotator cuff by ultrasonography must be guarded against and that arthrosonography is an effective alternative method in the postoperative integrity assessment. Also, an arthrosonography seems to be a suitable modality to replace the conventional ultrasonography.

Keyword

Shoulder; Rotator cuff retear; Ultrasonography; Arthrosonography

MeSH Terms

Adult
Aged
Aged, 80 and over
Arthrography
Arthroscopy
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Rotator Cuff/injuries/physiopathology/surgery/*ultrasonography
Shoulder Joint/physiopathology/surgery/*ultrasonography
Tendon Injuries/diagnosis/physiopathology/surgery/*ultrasonography
Wound Healing

Figure

• 

  Fig. 1 (A) The oblique coronal T1-weighted image of magnetic resonance arthrography (MRA) with fluid signal transversing full-thickness of the tendon shows a full-thickness tear of the rotator cuff. (B) The oblique coronal T1-weighted image of MRA with a fluid transversing portion of the articular side of the tendon shows a partial-thickness tear of the rotator cuff.

• 

  Fig. 2 (A) Although the longitudinal image of conventional ultrasonography after arthroscopic rotator cuff repair demonstrates a focal flattening of the convexity of the supraspinatus tendon (arrow), this finding could not confirm the diagnosis of full-thickness tear of the rotator cuff. (B) On an oblique coronal T1-weighted image of magnetic resonance arthrography, the repaired rotator cuff shows the full-thickness tear of the supraspinatus tendon and increased effusion of the subacromial space. (C) On a longitudinal image of arthrosonography, the repaired rotator cuff shows a full-thickness tear of the supraspinatus tendon and an increased effusion of the subacromial space (asterisk). H: humeral head.

Reference

1. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005; 87(6):1229–1240.

2. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000; 82(4):505–515.

3. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am. 2007; 89(5):953–960.

4. Crass JR, Craig EV, Feinberg SB. Sonography of the postoperative rotator cuff. AJR Am J Roentgenol. 1986; 146(3):561–564.

5. Prickett WD, Teefey SA, Galatz LM, Calfee RP, Middleton WD, Yamaguchi K. Accuracy of ultrasound imaging of the rotator cuff in shoulders that are painful postoperatively. J Bone Joint Surg Am. 2003; 85(6):1084–1089.

6. Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff: a comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000; 82(4):498–504.

7. Mack LA, Matsen FA 3rd, Kilcoyne RF, Davies PK, Sickler ME. US evaluation of the rotator cuff. Radiology. 1985; 157(1):205–209.

8. Miniaci A, Salonen D. Rotator cuff evaluation: imaging and diagnosis. Orthop Clin North Am. 1997; 28(1):43–58.

9. Mack LA, Nyberg DA, Matsen FR 3rd, Kilcoyne RF, Harvey D. Sonography of the postoperative shoulder. AJR Am J Roentgenol. 1988; 150(5):1089–1093.

10. Oh JH, Kim SH, Ji HM, Jo KH, Bin SW, Gong HS. Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy. 2009; 25(1):30–39.

11. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006; 15(3):290–299.

12. Gusmer PB, Potter HG, Donovan WD, O'Brien SJ. MR imaging of the shoulder after rotator cuff repair. AJR Am J Roentgenol. 1997; 168(2):559–563.

13. Magee TH, Gaenslen ES, Seitz R, Hinson GA, Wetzel LH. MR imaging of the shoulder after surgery. AJR Am J Roentgenol. 1997; 168(4):925–928.

14. Duc SR, Mengiardi B, Pfirrmann CW, Jost B, Hodler J, Zanetti M. Diagnostic performance of MR arthrography after rotator cuff repair. AJR Am J Roentgenol. 2006; 186(1):237–241.

15. Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd. Repairs of the rotator cuff: correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991; 73(7):982–989.

16. Lee HS, Joo KB, Park CK, et al. Sonography of the shoulder after arthrography (arthrosonography): preliminary results. J Clin Ultrasound. 2002; 30(1):23–32.

17. Seltzer SE, Finberg HJ, Weissman BN, Kido DK, Collier BD. Arthrosonography: gray-scale ultrasound evaluation of the shoulder. Radiology. 1979; 132(2):467–468.

18. Seltzer SE, Finberg HJ, Weissman BN. Arthrosonography: technique, sonographic anatomy, and pathology. Invest Radiol. 1980; 15(1):19–28.

19. Iannotti JP, Ciccone J, Buss DD, et al. Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears. J Bone Joint Surg Am. 2005; 87(6):1305–1311.

20. Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears: comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004; 86(4):708–716.

21. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984; 66(4):563–567.

22. Kamath G, Galatz LM, Keener JD, Teefey S, Middleton W, Yamaguchi K. Tendon integrity and functional outcome after arthroscopic repair of high-grade partial-thickness supraspinatus tears. J Bone Joint Surg Am. 2009; 91(5):1055–1062.

23. Lee HS, Lee KW, Han TI, et al. Arthrosonography of the shoulder joint for evaluation of the glenoid labrum, glenoid rim and humeral head: comparison with conventional ultrasonography and MR arthrography. J Korean Radiol Soc. 2003; 48(1):69–76.

24. Charousset C, Bellaiche L, Duranthon LD, Grimberg J. Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br. 2005; 87(6):824–828.

25. Knudsen HB, Gelineck J, Sojbjerg JO, Olsen BS, Johannsen HV, Sneppen O. Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg. 1999; 8(3):242–246.

26. Ferrari FS, Governi S, Burresi F, Vigni F, Stefani P. Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation. Eur Radiol. 2002; 12(5):1211–1217.

27. Waldt S, Bruegel M, Mueller D, et al. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol. 2007; 17(2):491–498.

28. Levy O, Venkateswaran B, Even T, Ravenscroft M, Copeland S. Mid-term clinical and sonographic outcome of arthroscopic repair of the rotator cuff. J Bone Joint Surg Br. 2008; 90(10):1341–1347.

29. Park JY, Siti HT, Keum JS, Moon SG, Oh KS. Does an arthroscopic suture bridge technique maintain repair integrity?: a serial evaluation by ultrasonography. Clin Orthop Relat Res. 2010; 468(6):1578–1587.

30. Ko SH, Friedman D, Seo DK, Jun HM, Warner JJ. A prospective therapeutic comparison of simple suture repairs to massive cuff stitch repairs for treatment of small- and medium-sized rotator cuff tears. Arthroscopy. 2009; 25(6):583–589.e4.