146 AJR:211, July 2018 Postoperative MRI of Massive Rotator Cuff Tears Mohammad Samim 1 Pamela Walsh 1 Soterios Gyftopoulos 1 Robert Meislin 2 Luis S. Beltran 1 Samim M, Walsh P, Gyftopoulos S, Meislin R, Beltran LS 1 Department of Radiology, NYU Langone Orthopedic Hospital, 301 East 17th St, Rm 600, New York, NY 10003. Address correspondence to M. Samim (Mohammad.samim@nyumc.org). 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY. Musculoskeletal Imaging • Review This article is available for credit. AJR 2018; 211:146–154 0361–803X/18/2111–146 © American Roentgen Ray Society Keywords: massive rotator cuff tear, MRI, postoperative, superior capsular reconstruction doi.org/10.2214/AJR.17.19281 Received November 13, 2017; accepted after revision December 11, 2017. tion (SCR) [12], and biodegradable subacro- mial balloon implantation [13]. As arthroscopic and augmentation tech- niques for the treatment of massive RCTs advance, radiologists will become increas- ingly likely to encounter postoperative imag- ing studies after surgical repair using these techniques; therefore, it is important for ra- diologists to be familiar with the different surgical techniques and their postoperative appearances. The goal of this article is to re- view newer surgical techniques, including patch repair, muscle tendon transfer, SCR, and subacromial balloon implantation, in ad- dition to their indication for treatment of ir- reparable massive RCTs. We discuss the nor- mal postoperative MRI appearance after the techniques are performed for massive RCT, in addition to the potential complications and failures associated with these procedures. Treatment Options Whenever feasible, a complete primary anatomic repair of symptomatic RCT should be performed; however, for massive RCT, primary repair is not always possible. Also, despite recent advances in arthroscopy in- struments and techniques, which have led to an increased number of arthroscopic re- pairs of massive RCTs [4], the rate of retear still remains high, ranging from 45% to 96% [14–16]. In these circumstances, tendon dé- bridement can be performed to achieve pain relief and some improved function [17]. The M assive rotator cuff tears (RCTs) comprise up to 40% of all RCTs [1] and are particularly challeng- ing for orthopedic surgeons to manage for several reasons. One reason is that different defnitions of massive RCT appear in the literature, making RCTs diffcult to con- sistently diagnose and treat, with the most commonly used defnitions including the Co- feld criterion [2], which requires measure- ment of a 5-cm tear in the coronal plane on MRI, and the description by Gerber et al. [3], who identifed massive RCTs as full-thickness tears involving at least two adjacent tendons. Technical and biologic challenges associated with repair of massive RCTs also exist, includ- ing poor quality of the retracted inelastic ten- don tissues, scarring, muscle atrophy, and fat- ty degeneration of the cuff muscles [1]. Furthermore, massive RCTs are usually asso- ciated with a poorer outcome after primary repair, including a higher rate of retear [4]. Different surgical treatment options are available for symptomatic massive RCTs, in- cluding arthroscopic débridement with or without biceps tenotomy [5, 6], partial [7] or complete [8] primary repair as long as the ro- tator cuff tendon has good quality and is not severely retracted, and reverse shoulder ar- throplasty [9]. Several newer augmentation techniques for irreparable massive RCTs have been introduced, including patch graft aug- mentation and bridging [9], muscle tendon transfer [10–12], superior capsular reconstruc- OBJECTIVE. The aim of this article is to review the postoperative MRI appearances of irreparable massive rotator cuff tears (RCTs) after surgery was performed using newer tech- niques, including patch repair, muscle tendon transfer, superior capsular reconstruction, and subacromial balloon implantation. CONCLUSION. Newer surgical techniques are emerging for the management of mas- sive RCTs. As radiologists become increasingly likely to encounter postoperative imaging studies of RCTs repaired using these techniques, familiarity with the normal postoperative appearances and complications associated with these techniques becomes important. Samim et al. Postoperative MRI of RCTs Musculoskeletal Imaging Review Downloaded from www.ajronline.org by 34.232.64.139 on 10/13/21 from IP address 34.232.64.139. Copyright ARRS. For personal use only; all rights reserved