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Semin Musculoskelet Radiol 2025; 29(01): 124-133
DOI: 10.1055/s-0044-1796634
Review Article

Imaging of Reparable and Irreparable Rotator Cuff Tears

Sindhoora Murthy 
1   Department of Radiology, New York University, Langone School of Medicine, New York, New York
4   Department of Radiology, NYU Langone Medical Center, New York, New York
,
Michelle Shen
2   Department of Orthopedic Surgery, New York University, Langone School of Medicine, New York, New York
,
Diego F. Lemos
3   Department of Radiology, The University of Vermont Medical Center, Burlington, Vermont
,
Michael J. Alaia
2   Department of Orthopedic Surgery, New York University, Langone School of Medicine, New York, New York
,
Erin F. Alaia
4   Department of Radiology, NYU Langone Medical Center, New York, New York
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Abstract

This review offers a comprehensive discussion of magnetic resonance imaging (MRI) for the assessment of rotator cuff tendon repair and joint-preserving surgical options for patients with irreparable rotator cuff tears. Deciding to proceed with arthroscopic repair of a rotator cuff tendon tear is impacted both by clinical factors and morphological imaging features. Preoperative clinical and imaging features also predict the likelihood of success of a rotator cuff tendon repair and are important to recognize. In patients with irreparable rotator cuff tears and relatively preserved glenohumeral cartilage, various joint-preserving surgical options are available and seen increasingly in clinical practice.

The acceptable range of postoperative imaging findings correlating with a functionally intact rotator cuff repaired tendon, and MRI findings that are either suggestive of or definitive for rotator cuff tendon repair failure are discussed in detail, with attention to the Sugaya classification. Ancillary features, such as progressive retraction of the myotendinous junction and the degree of muscle fatty atrophy, can be used as problem-solving tools in cases equivocal for rotator cuff retear. Finally, this review discusses in detail the most common joint-preserving treatment options for patients with irreparable rotator cuff tears, including an in-depth focus on superior capsular reconstruction.

Keywords

rotator cuff - repair - outcomes - irreparable - reparable


Publication History

Article published online:
11 February 2025

© 2025. Thieme. All rights reserved.

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  • References

  • 1 Gutman MJ, Joyce CD, Patel MS. et al. Early repair of traumatic rotator cuff tears improves functional outcomes. J Shoulder Elbow Surg 2021; 30 (11) 2475-2483
    CrossrefPubMedSearch in Google Scholar
  • 2 Park JY, Lee JH, Oh KS. et al. Rotator cuff retear after repair surgery: comparison between experienced and inexperienced surgeons. Clin Shoulder Elbow 2021; 24 (03) 135-140
    CrossrefPubMedSearch in Google Scholar
  • 3 Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004; 86 (02) 219-224
    CrossrefPubMedSearch in Google Scholar
  • 4 Tashjian RZ, Hollins AM, Kim HM. et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 2010; 38 (12) 2435-2442
    CrossrefPubMedSearch in Google Scholar
  • 5 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 (05) 953-960
    CrossrefPubMedSearch in Google Scholar
  • 6 Frank JB, ElAttrache NS, Dines JS, Blackburn A, Crues J, Tibone JE. Repair site integrity after arthroscopic transosseous-equivalent suture-bridge rotator cuff repair. Am J Sports Med 2008; 36 (08) 1496-1503
    CrossrefPubMedSearch in Google Scholar
  • 7 Zhao J, Luo M, Pan J. et al. Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg 2021; 30 (11) 2660-2670
    CrossrefPubMedSearch in Google Scholar
  • 8 Fan N, Yuan S, Du P. et al. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31 (03) 656-667
    CrossrefPubMedSearch in Google Scholar
  • 9 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 (01) 30-39
    CrossrefPubMedSearch in Google Scholar
  • 10 Rossi LA, Chahla J, Verma NN, Millett PJ, Ranalletta M. Rotator cuff retears. JBJS Rev 2020; 8 (01) e0039
    CrossrefPubMedSearch in Google Scholar
  • 11 Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994; (304) 78-83
    PubMedSearch in Google Scholar
  • 12 Tsuchiya S, Bois AJ, Matthewson G, Oiwa S, More KD, Lo IKY. The relationship between preoperative Goutallier stage and retear rates following posterosuperior rotator cuff repair: a systematic review. J Shoulder Elbow Surg 2023; 32 (02) 435-443
    CrossrefPubMedSearch in Google Scholar
  • 13 Gladstone JN, Bishop JY, Lo IK, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 2007; 35 (05) 719-728
    CrossrefPubMedSearch in Google Scholar
  • 14 Bogdanov J, Lan R, Chu TN, Bolia IK, Weber AE, Petrigliano FA. Fatty degeneration of the rotator cuff: pathogenesis, clinical implications, and future treatment. JSES Rev Rep Tech 2021; 1 (04) 301-308
    PubMedSearch in Google Scholar
  • 15 Jensen AR, Taylor AJ, Sanchez-Sotelo J. Factors influencing the reparability and healing rates of rotator cuff tears. Curr Rev Musculoskelet Med 2020; 13 (05) 572-583
    CrossrefPubMedSearch in Google Scholar
  • 16 Reddy RP, Solomon DA, Hughes JD, Lesniak BP, Lin A. Clinical outcomes of rotator cuff repair in patients with concomitant glenohumeral osteoarthritis. J Shoulder Elbow Surg 2022; 31 (6S): S25-S33
    CrossrefPubMedSearch in Google Scholar
  • 17 Dines JS, Bedi A, ElAttrache NS, Dines DM. Single-row versus double-row rotator cuff repair: techniques and outcomes. J Am Acad Orthop Surg 2010; 18 (02) 83-93
    CrossrefPubMedSearch in Google Scholar
  • 18 Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 2005; 21 (11) 1307-1316
    CrossrefPubMedSearch in Google Scholar
  • 19 Zanetti M, Jost B, Hodler J, Gerber C. MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects. Skeletal Radiol 2000; 29 (06) 314-319
    CrossrefPubMedSearch in Google Scholar
  • 20 Muniandy M, Niglis L, Claude Dosch J, Meyer N, Kempf JF, Collin P. Société française de chirurgie orthopédique et traumatologique (SoFCOT). Postoperative rotator cuff integrity: can we consider type 3 Sugaya classification as retear?. J Shoulder Elbow Surg 2021; 30 (01) 97-103
    CrossrefPubMedSearch in Google Scholar
  • 21 Calvert PT, Packer NP, Stoker DJ, Bayley JI, Kessel L. Arthrography of the shoulder after operative repair of the torn rotator cuff. J Bone Joint Surg Br 1986; 68 (01) 147-150
    CrossrefPubMedSearch in Google Scholar
  • 22 Kim SC, Shim SB, Kim WJ, Yoo JC. Preoperative rotator cuff tendon integrity, tear size, and muscle atrophy and fatty infiltration are associated with structural outcomes of arthroscopic revision rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2022; 30 (06) 2029-2038
    CrossrefPubMedSearch in Google Scholar
  • 23 Wu XL, Briggs L, Murrell GA. Intraoperative determinants of rotator cuff repair integrity: an analysis of 500 consecutive repairs. Am J Sports Med 2012; 40 (12) 2771-2776
    CrossrefPubMedSearch in Google Scholar
  • 24 Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy 1994; 10 (04) 363-370
    CrossrefPubMedSearch in Google Scholar
  • 25 Di Benedetto ED, Di Benedetto P, Fiocchi A, Beltrame A, Causero A. Partial repair in irreparable rotator cuff tear: our experience in long-term follow-up. Acta Biomed 2017; 88 (4S): 69-74
    PubMedSearch in Google Scholar
  • 26 Gillespie RJ, Knapik DM, Akkus O. Biologic and synthetic grafts in the reconstruction of large to massive rotator cuff tears. J Am Acad Orthop Surg 2016; 24 (12) 823-828
    CrossrefPubMedSearch in Google Scholar
  • 27 Avanzi P, Giudici LD, Capone A. et al. Prospective randomized controlled trial for patch augmentation in rotator cuff repair: 24-month outcomes. J Shoulder Elbow Surg 2019; 28 (10) 1918-1927
    CrossrefPubMedSearch in Google Scholar
  • 28 Burkhart SS, Hartzler RU. Superior capsular reconstruction reverses profound pseudoparalysis in patients with irreparable rotator cuff tears and minimal or no glenohumeral arthritis. Arthroscopy 2019; 35 (01) 22-28
    CrossrefPubMedSearch in Google Scholar
  • 29 Mihata T, Lee TQ, Hasegawa A. et al. arthroscopic superior capsule reconstruction can eliminate pseudoparalysis in patients with irreparable rotator cuff tears. Am J Sports Med 2018; 46 (11) 2707-2716
    CrossrefPubMedSearch in Google Scholar
  • 30 Yamamoto N, Itoi E. Treatment of irreparable rotator cuff tears with superior capsular reconstruction. J Exp Orthop 2021; 8 (01) 23
    CrossrefPubMedSearch in Google Scholar
  • 31 Tokish JM, Makovicka JL. The Superior capsular reconstruction: lessons learned and future directions. J Am Acad Orthop Surg 2020; 28 (13) 528-537
    CrossrefPubMedSearch in Google Scholar
  • 32 Samim M, Walsh P, Gyftopoulos S, Meislin R, Beltran LS. Postoperative MRI of massive rotator cuff tears. AJR Am J Roentgenol 2018; 211 (01) 146-154
    CrossrefPubMedSearch in Google Scholar
  • 33 Campbell AL, Baron SL, Pham H, Gyftopoulos S, Meislin R, Samim M. MRI of superior capsular reconstruction graft and associated short-term clinical outcomes in patients with massive irreparable rotator cuff tears. Clin Imaging 2021; 70: 74-80
    CrossrefPubMedSearch in Google Scholar
  • 34 Gerber C, Vinh TS, Hertel R, Hess CW. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report. Clin Orthop Relat Res 1988; (232) 51-61
    PubMedSearch in Google Scholar
  • 35 Gavriilidis I, Kircher J, Magosch P, Lichtenberg S, Habermeyer P. Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. Int Orthop 2010; 34 (05) 689-694
    CrossrefPubMedSearch in Google Scholar
  • 36 Burnier M, Lafosse T. Pectoralis major and anterior latissimus dorsi transfer for subscapularis tears. Curr Rev Musculoskelet Med 2020; 13 (06) 725-733
    CrossrefPubMedSearch in Google Scholar
  • 37 Elhassan BT, Alentorn-Geli E, Assenmacher AT, Wagner ER. Arthroscopic-assisted lower trapezius tendon transfer for massive irreparable posterior-superior rotator cuff tears: surgical technique. Arthrosc Tech 2016; 5 (05) e981-e988
    CrossrefPubMedSearch in Google Scholar
  • 38 Balazs CGC. Editorial commentary: Subacromial balloon spacer for irreparable rotator cuff tears produces clinical improvement, yet the mechanism of action is unclear. Arthroscopy 2024; 40 (02) 551-552
    CrossrefPubMedSearch in Google Scholar
  • 39 Metcalfe A, Parsons H, Parsons N. et al; START:REACTS team. Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): a group-sequential, double-blind, multicentre randomised controlled trial. Lancet 2022; 399 (10339): 1954-1963
    CrossrefPubMedSearch in Google Scholar
  • 40 Ravenscroft M, Barnes MW, Muench LN, Mazzocca AD, Berthold DP. Bursal acromial reconstruction (BAR) using an acellular dermal allograft as a surgical solution for the treatment of massive irreparable rotator cuff tears. Arthrosc Tech 2021; 10 (03) e877-e885
    CrossrefPubMedSearch in Google Scholar
  • 41 De Giacomo AF, Park MC, Lee TQ. Anterior cable reconstruction using the proximal biceps tendon for large rotator cuff defects. Arthrosc Tech 2021; 10 (03) e807-e813
    CrossrefPubMedSearch in Google Scholar