ARRS 2022 Abstracts


E1685. MRI Findings Predisposing to Rotator Cuff Augmentation Failure
  1. Kimberley Brown; McGovern Medical School
  2. Manickam Kumaravel; McGovern Medical School
  3. Gregory Blazek; McGovern Medical School
Rotator cuff tears are common injuries amongst adults of all ages, with irreparable rotator cuff tears being shown to lead to tendon retraction, inelasticity, muscular atrophy, and fatty infiltration. Various procedures are available to restore stability and function; for example, rotator cuff augmentation with superior capsular reconstruction utilizing a dermal graft; however, little information is known about the biological fate of these grafts in human subjects. The purpose of this study is to analyze MRI findings before and after rotator cuff augmentation to identify pre-surgical factors that may predispose to augmentation repair failure, defined as Sugaya classification 3 or greater. In addition, this study will describe imaging findings associated with rotator cuff augmentation failure.

Materials and Methods:
In a retrospective study, the imaging and surgical data from 27 patients who have previously received elective augmentation rotator cuff repairs at Memorial Hermann have been analyzed. Patients were collected through a PACS boolean search and pre- and postoperative imaging findings were reviewed. Specific imaging findings, such as tendon injured, muscle atrophy, joint effusion, bone quality, tendon/graft tear size in craniocaudal (CC) and anterior posterior (AP) dimensions, graft characteristics were documented, along with the time from initial imaging to post-operative imaging. A focus was placed on postoperative graft thickness and characteristics to assign a Sugaya classification, with class 1–2 defined as graft success and class 3–5 defined as graft failure.

Fisher's exact test was used to evaluate association of graft characteristics with outcomes, and a multivariable logistic regression analysis was performed for graft success. Variables having p values less than 0.2 in univariate analysis included CC tear thickness, AP tear thickness, pre-op glenohumeral fluid, pre-op subacromial fluid, and pre-op effusion. The two thickness variables showed moderate correlation (r = 0.55, 95% CI 0.14–0.79). A forward stepwise selection algorithm with Akaike information criterion was implemented to select thickness (AP) and pre-op effusion as variables of interest. AP thickness was broken down by median (= 18 mm) and pre-op effusion was dichotomized to levels 0 (absent) and 1–3 (present). A statically significant correlation was noted between graft failure and pre-operative tear thickness in AP dimension (p = 0.032) and pre-operative joint effusion (p = 0.055).

Based on the current data and analysis, the size of the rotator cuff tear and size of effusion have shown to be correlated with rotator cuff graft failure, with post-operative graft classified as Sugaya 3 or greater. With continuation of this study and expansion of the data, our goal is to identify a concrete set of imaging findings that can predict poor graft outcomes or failure. This will in turn help surgeons identify non-ideal patients for superior capsular reconstruction and provide alternate treatment options.