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Evaluation of Muscular Atrophy and Fatty Infiltration Using Time-zero Magnetic Resonance Imaging as Baseline Data, After Rotator Cuff Repair
Clin Should Elbow 2019;22:70-78
Published online June 1, 2019;  https://doi.org/10.5397/cise.2019.22.2.70
© 2019 Korean Shoulder and Elbow Society.

Hyoung Bok Kim, Jae Chul Yoo1, Jeung Yeol Jeong2

Department of Orthopedic Surgery, Bumin Hospital Seoul, 1Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, 2Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, Korea
Correspondence to: Jeung Yeol Jeong
Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, 7 Keunjaebong-gil, Hwaseong 18450, Korea
Tel: +82-31-8086-2410, Fax: +82-31-8086-2029, E-mail: inzaghy@naver.com, ORCID: https://orcid.org/0000-0001-8145-1302
IRB approval: Samsung Medical Center (No. SMC: 2016-02-019).
Received December 31, 2018; Revised February 3, 2019; Accepted February 6, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: This study evaluated postoperative changes in the supraspinatus from time-zero to 6 months, using magnetic resonance imaging (MRI). We hypothesized that restoration of the musculotendinous unit of the rotator cuff by tendon repair immediately improves the rotator cuff muscle status, and maintains it months after surgery.
Methods: Totally, 76 patients (29 men, 47 women) with rotator cuff tears involving the supraspinatus tendon who underwent arthroscopic rotator cuff repairs were examined. MRI evaluation showed complete repair with intact integrity of the torn tendon at both time-zero and at 6 months follow-up. All patients underwent standardized MRI at our institution preoperatively, at 1 or 2 days postoperative, and at 6 months after surgery. Supraspinatus muscular (SSP) atrophy (Thomazeau grade) and fatty infiltrations (Goutallier stage) were evaluated by MRI. The cross-sectional area of SSP in the fossa was also measured. 
Results: As determined by MRI, the cross-sectional area of SSP significantly decreased 11.41% from time-zero (immediate repair) to 6 months post-surgery, whereas the Goutallier stage and Thomazeau grade showed no significant changes (p<0.01). Furthermore, compared to the preoperative MRI, the postoperative MRI at 6 months showed a no statistically significant increase of 8.03% in the cross-sectional area. In addition, morphological improvements were observed in patients with high grade Goutallier and Thomazeau at time-zero, whereas morphology of patients with low grade factors were almost similar to before surgery.
Conclusions: Our results indicate that cross-sectional area of the initial repair appears to decrease after a few months postoperatively, possibly due to medial retraction or strained muscle.
Keywords : Muscular atrophy; Fatty infiltration; Rotator cuff repair; Time-zero magnetic resonance imaging