The Fate of Sutures Post Rotator Cuff Repair
These authors used ultrasound to sequentially characterize the supraspinatus insertion after arthroscopic repair in 21 patients, 14 (67%) with full thickness tears and 7 (33%) with partial thickness tears. During each assessment the total supraspinatus tendon thickness, the thickness of tendon tissues
below and above the sutures, the anatomical footprint and the modulus of elasticity were measured.
Longitudinal and Schematic View of the Left Supraspinatus Tendon:
(a) Anatomical footprint,
(b) Tendon thickness at the footprint-articular junction,
(c) Bursal to suture tendon thickness at footprint-articular junction (FAJ),
(d) Suture to articular surface tendon thickness at FAJ,
(e) Tendon thickness at medial tip of the suture,
(f) Bursal to suture tendon thickness at medial tip of the suture,
(g) Suture to articular surface tendon thickness at medial tip of the suture
(h) Location where tendon stiffness and modulus of elasticity were measured with shear wave elastography in which a focused ultrasonic pulse provides qualitative and quantitative information on the elasticity and stiffness of a tissue.
Within the first 12 weeks after repair, the sutures migrated from the surface through to the middle of the tendon at the footprint-articular junction (i.e., ratio of tendon tissue thickness below the suture to the total tendon thickness was 0.5).
The mean anatomical footprint increased from 8.4 mm to 9.1 mm between 8 days and 6 weeks.
Bursal thickness decreased during the 24-week period from 1.5 mm to 0.7 mm.
Tendon modulus of elasticity increased from 154 kPa to 205 kPa between 8 days and 24 weeks.
Comment: This is an interesting study that demonstrates the change in relative suture position, repair site anatomy, and structural properties of the repaired tendon. As suggested by the previous post, it would have been of interest to see how the ultrasonographic appearance correlated with the MRI appearance during this period of time after surgical repair.
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