Zusammenfassung
Fragestellung: Der Nutzen der MRT zur präoperativen Beurteilung der Rotatorenmanschette ist erwiesen. Trotz der klinischen Relevanz existieren nur wenige Untersuchungen zur MRT-Bildgebung an bereits operierten Patienten. So erhebt sich die Frage, inwieweit die postoperative MRT einen Beitrag zur Beurteilung der Integrität der Rotatorenmanschette liefern kann. Methode: Mindestens 10 Monate nach erfolgreicher Rekonstruktion der Supraspinatussehne, die zumeist mit einer subakromialen Dekompression nach Neer kombiniert wurde, erfolgte eine MRT in einem 1,5-Tesla-Sytem an 33 Gelenken. Nur Patienten, die mit dem Operationsergebnis zufrieden waren und 65 bis 100 Punkte im Constant-Score zeigten, wurden in die Studie eingeschlossen. Ergebnisse: Bei über der Hälfte der Patienten waren die direkten Diagnosekriterien einer partiellen bzw. vollständigen Sehnenruptur, wie Signalgebung und Morphologie der Sehne, positiv. Aber auch die indirekten Diagnosekriterien nach Zlatkin, wie die Beurteilung der subdeltoidalen bzw. subakromialen Fettschicht und das Auftreten subdeltoidaler bzw. subakromialer Flüssigkeit, waren häufig positiv. Zudem wurde eine Atrophie des M. supraspinatus, als ein weiteres indirektes Diagnosekriterium einer Ruptur, häufig beobachtet. Schlussfolgerung: In Anbetracht der exzellenten klinischen Ergebnisse unserer Patienten zeigt diese Untersuchung, dass postoperative MRT-Bilder mit Vorsicht beurteilt werden sollten. Es besteht ein hohes Risiko der Überbewertung erhobener MR-Befunde.
Abstract
Aim: The value of MRI for pre-operative evaluation of the rotator cuff is proven. In spite of its clinical relevance, there have been only few studies on MR imaging of patients who have already been operated. Thus, the question rises to what extent the post-operative MRI can contribute to the evaluation of the integrity of the rotator cuff. Method: At least 10 months after successful open repair of the supraspinatus tendon, mostly combined with Neer's anterior acromioplasty, an MR scan was performed on 33 shoulders. Only patients satisfied with the outcome of surgery and showing a Constant score of 65 to 100 points were included. Results: More than half the patients had positive direct diagnostic criteria for a full- or partial-thickness tear of the supraspinatus tendon, in the form of signal intensity or morphological alterations. In addition, the indirect diagnostic criteria described by Zlatkin, such as the absence of the subacromial-subdeltoid fat or the appearance of subacromial-subdeltoid fluid, were often positive. Atrophy of the supraspinatus muscle, as a further indirect diagnostic criterion of a rupture, was also frequently noted. Conclusion: Taking the excellent clinical outcome of our patients into consideration, this study shows that caution should be taken in evaluating postoperative MR images. There is a high risk of over-interpreting MR findings.
Schlüsselwörter
Schulter - MRT - Supraspinatussehne - Muskel
Key words
Shoulder - magnetic resonance - supraspinatus tendon - muscle
Literatur
1
Iannotti J P, Zlatkin M B, Esterhai J L, Kressel H Y, Dalinka M K, Spindler K P.
Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value.
J Bone Joint Surg [Am].
1991;
73
17-29
2
Kneeland J B, Middleton W D, Carrera G F, Zeuge R C, Jesmanowicz A, Froncisz W. et al .
MR imaging of the shoulder: diagnosis of rotator cuff tears.
AJR Am J Roentgenol.
1987;
149
333-337
3
Zlatkin M B, Iannotti J P, Roberts M C, Esterhai J L, Dalinka M K, Kressel H Y. et al .
Rotator cuff tears: diagnostic performance of MR imaging.
Radiology.
1989;
172
223-229
4
Zanetti M, Gerber C, Hodler J.
Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging.
Invest Radiol.
1998;
33
163-170
5
Bjorkenheim J M.
Structure and function of the rabbit's supraspinatus muscle after resection of its tendon.
Acta Orthop Scand.
1989;
60
461-463
6
Farley T E, Neumann C H, Steinbach L S, Jahnke A J, Petersen S S.
Full-thickness tears of the rotator cuff of the shoulder: diagnosis with MR imaging.
Am J Roentgenol.
1992;
158
347-351
7
Zanetti M, Jost B, Lustenberger A, Hodler J.
Clinical impact of MR arthrography of the shoulder.
Acta Radiol.
1999;
40
296-302
8
Samilson R L, Binder W F.
Symptomatic full thickness tears of rotator cuff. An analysis of 292 shoulders in 276 patients.
Orthop Clin North Am.
1975;
6
449-466
9
Wolfgang G L.
Surgical repair of tears of the rotator cuff of the shoulder. Factors influencing the result.
J Bone Joint Surg [Am].
1974;
56
14-26
10
Knudsen H B, Gelineck J, Sojbjerg J O, Olsen B S, Johannsen H V, Sneppen O.
Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction.
J Shoulder Elbow Surg.
1999;
8
242-246
11
Gaenslen E S, Satterlee C C, Hinson G W.
Magnetic resonance imaging for evaluation of failed repairs of the rotator cuff.
J Bone Joint Surg [Am].
1996;
78
1391-1396
12
Owen R S, Iannotti J P, Kneeland J B, Dalinka M K, Deren J A, Oleaga L.
Shoulder after surgery: MR imaging with surgical validation.
Radiology.
1993;
186
443-447
13
Magee T H, Gaenslen E S, Seitz R, Hinson G A, Wetzel L H.
MR imaging of the shoulder after surgery.
Am J Roentgenol.
1997;
168
925-928
14
Gusmer P B, Potter H G, Donovan W D, O'Brien S J.
MR imaging of the shoulder after rotator cuff repair.
Am J Roentgenol.
1997;
168
559-563
15 Neer C S. Shoulder reconstruction. Saunders, Philadelphia 1990
16
Constant C R, Murley A H.
A clinical method of functional assessment of the shoulder.
Clin Orthop.
1987;
214
160-164
17
Gazielly D F, Gleyze P, Montagnon C.
Functional and anatomical results after rotator cuff repair.
Clin Orthop.
1994;
304
43-53
18
Thomazeau H, Rolland Y, Lucas C, Duval J M, Langlais F.
Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology.
Acta Orthop Scand.
1996;
67
264-268
19
Kjellin I, Ho C P, Cervilla V, Haghighi P, Kerr R, Vangness C T, Friedman R J, Trudell D, Resnick D.
Alterations in the supraspinatus tendon at MR imaging: correlation with histopathologic findings in cadavers.
Radiology.
1991;
181
837-841
20
Singson R D, Hoang T, Dan S, Friedman M.
MR evaluation of rotator cuff pathology using T2 -weighted fast spin-echo technique with and without fat suppression.
AJR Am J Roentgenol.
1996;
166
1061-1065
21
Haygood T M, Oxner K G, Kneeland J B, Dalinka M K.
Magnetic resonance imaging of the postoperative shoulder.
Magn Reson Imaging Clin N Am.
1993;
1
143-155
22
Loehr J F, Helmig P, Sojbjerg J O, Jung A.
Shoulder instability caused by rotator cuff lesions. An in vitro study.
Clin Orthop.
1994;
304
84-90
23
Schaefer O, Winterer J, Lohrmann C, Laubenberger J, Reichelt A, Langer M.
Magnetic resonance imaging for supraspinatus muscle atrophy after cuff repair.
Clin Orthop.
2002;
403
93-99
Dr. med. Lars Victor v. Engelhardt
Klinik und Poliklinik für Orthopädie
Sigmund-Freud-Str. 25
53105 Bonn
Fax: 02 28-2 87 90 91
Email: LarsVictor@gmx.de