Skip to main content
SpringerLink
Log in

Postoperative residual pain is associated with a high magnetic resonance imaging (MRI)-based signal intensity of the repaired supraspinatus tendon

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess patients with and without postoperative residual pain and to compare clinical function and magnetic resonance imaging (MRI) appearance of the repaired supraspinatus tendon between patients with and without pain.

Methods

One-hundred and seventeen patients with supraspinatus tear were included in this study. Visual Analog Scale (VAS) scores for pain were assessed at a follow-up of at least 1 year. Patients with residual shoulder pain were enrolled in the residual pain group (RP group) and patients without pain enrolled in the no pain group (NP group). The American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, the modified University of California at Los Angeles (UCLA) score and the Fudan University Shoulder Score (FUSS) were also used to evaluate shoulder function. MRI examinations were performed to evaluate rotator cuff integrity according to the Sugaya method, and muscular hypotrophy, fatty infiltration, and signal/noise quotient (SNQ) of the rotator cuff tendon.

Results

Thirty-five patients had residual pain (RP group) and 82 patients had no pain (NR group). At the final follow-up, there was a significant difference in ASES (92 ± 8 points vs 76 ± 10 points; p < 0.001), UCLA (32 ± 3 points vs 28 ± 3 points; p < 0.001), FUSS (90 ± 7 points vs 80 ± 9 points; p < 0.001) and strength (9 ± 3 kg vs 6 ± 2 kg; p < 0.001) between the NP group and the RP group, respectively. Postoperative MRI revealed that there was no significant difference in the retear rate (9.8% vs 8.6%; ns), the muscular hypotrophy (ns), and the fatty infiltration index (0.9 ± 0.2 vs 0.9 ± 0.2; ns) between the NP and the RP groups, respectively. The postoperative tendon SNQ of the RP group was significantly higher than that of the NP group (4.6 ± 2.5 vs 3 ± 1.7; p < 0.001). There was a significant association between tendon SNQ and VAS for this cohort (\( \rho\) = 0.29; p = 0.003).

Conclusion

Postoperative residual pain is associated with a high MRI signal intensity of the repaired supraspinatus tendon. Since high signal intensity of tendon tissue indicates degenerated tendon tissue quality, it highlighted the necessity of debriding the degenerated rotator cuff tendon tissue.

Level of evidence

III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aydin N, Kocaoglu B, Guven O (2010) Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears. J Shoulder Elb Surg 19(5):722–725

    Google Scholar 

  2. Barber FA (2016) Triple-loaded single-row versus suture-bridge double-row rotator cuff tendon repair with platelet-rich plasma fibrin membrane: a randomized controlled trial. Arthroscopy 32(5):753–761

    PubMed  Google Scholar 

  3. Blaine TA, Cote MA, Proto A, Mulcahey M, Lee FY, Bigliani LU (2011) Interleukin-1beta stimulates stromal-derived factor-1alpha expression in human subacromial bursa. J Orthop Res 29(11):1695–1699

    CAS  PubMed  Google Scholar 

  4. Blaine TA, Kim YS, Voloshin I, Chen D, Murakami K, Chang SS, Winchester R, Lee FY, O’Keefe RJ, Bigliani LU (2005) The molecular pathophysiology of subacromial bursitis in rotator cuff disease. J Shoulder Elb Surg 14(1 Suppl S):84S–89S

    Google Scholar 

  5. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005) Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Jt Surg Am 87(6):1229–1240

    Google Scholar 

  6. Boyer P, Bouthors C, Delcourt T, Stewart O, Hamida F, Mylle G, Massin P (2015) Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques. Knee Surg Sports Traumatol Arthrosc 23(2):478–486

    CAS  PubMed  Google Scholar 

  7. Charousset C, Bellaiche L, Kalra K, Petrover D (2010) Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older? Arthroscopy 26(3):302–309

    PubMed  Google Scholar 

  8. Chen Y, Li H, Qiao Y, Ge Y, Li Y, Hua Y, Chen J, Chen S (2019) Double-row rotator cuff repairs lead to more intensive pain during the early postoperative period but have a lower risk of residual pain than single-row repairs. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05346-0

    Article  PubMed  Google Scholar 

  9. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  10. Crim J, Burks R, Manaster BJ, Hanrahan C, Hung M, Greis P (2010) Temporal evolution of MRI findings after arthroscopic rotator cuff repair. AJR Am J Roentgenol 195(6):1361–1366

    PubMed  Google Scholar 

  11. DeHaan AM, Axelrad TW, Kaye E, Silvestri L, Puskas B, Foster TE (2012) Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review. Am J Sports Med 40(5):1176–1185

    PubMed  Google Scholar 

  12. Elliott RSJ, Lim YJ, Coghlan J, Troupis J, Bell S (2019) Structural integrity of rotator cuff at 16 years following repair: good long-term outcomes despite recurrent tears. Shoulder Elb 11(1):26–34

    Google Scholar 

  13. Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Jt Surg Am 68(8):1136–1144

    CAS  Google Scholar 

  14. Fehringer EV, Sun J, VanOeveren LS, Keller BK, Matsen FA 3rd (2008) Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. J Shoulder Elb Surg 17(6):881–885

    Google Scholar 

  15. Franceschi F, Papalia R, Franceschetti E, Palumbo A, Del Buono A, Paciotti M, Maffulli N, Denaro V (2016) Double-row repair lowers the retear risk after accelerated rehabilitation. Am J Sports Med 44(4):948–956

    PubMed  Google Scholar 

  16. Ge Y, Chen S, Chen J, Hua Y, Li Y (2013) The development and evaluation of a new shoulder scoring system based on the view of patients and physicians: the Fudan University shoulder score. Arthroscopy 29(4):613–622

    PubMed  Google Scholar 

  17. Gerhardt C, Hug K, Pauly S, Marnitz T, Scheibel M (2012) Arthroscopic single-row modified mason-allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched-pair analysis. Am J Sports Med 40(12):2777–2785

    PubMed  Google Scholar 

  18. Gil JA, Gunaseelan V, DeFroda SF, Brummett CM, Bedi A, Waljee JF (2019) Risk of prolonged opioid use among opioid-naive patients after common shoulder arthroscopy procedures. Am J Sports Med 47(5):1043–1050

    PubMed  Google Scholar 

  19. Ide J, Karasugi T, Okamoto N, Taniwaki T, Oka K, Mizuta H (2015) Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears. J Shoulder Elb Surg 24(10):1544–1554

    Google Scholar 

  20. Jeon YS, Kim RG, Shin SJ (2017) What influence does progression of a nonhealing rotator cuff tear have on shoulder pain and function? Clin Orthop Relat Res 475(6):1596–1604

    PubMed  PubMed Central  Google Scholar 

  21. Khazzam M, Kuhn JE, Mulligan E, Abboud JA, Baumgarten KM, Brophy RH, Jones GL, Miller B, Smith M, Wright RW (2012) Magnetic resonance imaging identification of rotator cuff retears after repair: interobserver and intraobserver agreement. Am J Sports Med 40(8):1722–1727

    PubMed  Google Scholar 

  22. Kim JH, Hong IT, Ryu KJ, Bong ST, Lee YS, Kim JH (2014) Retear rate in the late postoperative period after arthroscopic rotator cuff repair. Am J Sports Med 42(11):2606–2613

    PubMed  Google Scholar 

  23. Kim KC, Shin HD, Lee WY, Han SC (2012) Repair integrity and functional outcome after arthroscopic rotator cuff repair: double-row versus suture-bridge technique. Am J Sports Med 40(2):294–299

    PubMed  Google Scholar 

  24. Lapner PL, Sabri E, Rakhra K, McRae S, Leiter J, Bell K, Macdonald P (2012) A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. J Bone Jt Surg Am 94(14):1249–1257

    Google Scholar 

  25. Lee JE, Park JS, Ryu KN, Rhee YG, Yoon SH, Park SY, Jin W (2015) Repaired supraspinatus tendons in clinically improving patients: early postoperative findings and interval changes on MRI. Korean J Radiol 16(2):363–371

    PubMed  PubMed Central  Google Scholar 

  26. Lee SH, Kim JW, Kim TK, Kweon SH, Kang HJ, Kim SJ, Park JS (2017) Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size? Knee Surg Sports Traumatol Arthrosc 25(7):2138–2146

    PubMed  Google Scholar 

  27. Lhee SH, Singh AK, Lee DY (2017) Does magnetic resonance imaging appearance of supraspinatus muscle atrophy change after repairing rotator cuff tears? J Shoulder Elb Surg 26(3):416–423

    Google Scholar 

  28. Li H, Chen Y, Chen J, Hua Y, Chen S (2018) Large critical shoulder angle has higher risk of tendon retear after arthroscopic rotator cuff repair. Am J Sports Med 46(8):1892–1900

    PubMed  Google Scholar 

  29. Malavolta EA, Gracitelli MEC, Assuncao JH, Ferreira Neto AA, Bordalo-Rodrigues M, de Camargo OP (2018) Clinical and structural evaluations of rotator cuff repair with and without added platelet-rich plasma at 5-year follow-up: a prospective randomized study. Am J Sports Med 46(13):3134–3141

    PubMed  Google Scholar 

  30. Michener LA, McClure PW, Sennett BJ (2002) American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elb Surg 11(6):587–594

    Google Scholar 

  31. Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ (2014) Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elb Surg 23(4):586–597

    Google Scholar 

  32. Nam JH, Park S, Lee HR, Kim SH (2018) Outcomes after limited or extensive bursectomy during rotator cuff repair: randomized controlled trial. Arthroscopy 34(12):3167–3174

    PubMed  Google Scholar 

  33. Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, Fukunaga T, Johnson CD, McHugh MP (2016) Functional outcomes after double-row versus single-row rotator cuff repair: a prospective randomized trial. Orthop J Sports Med 4(10):2325967116667398

    PubMed  PubMed Central  Google Scholar 

  34. Ravindra A, Barlow JD, Jones GL, Bishop JY (2018) A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. J Shoulder Elb Surg 27(10):1824–1829

    Google Scholar 

  35. Saccomanno MF, Cazzato G, Fodale M, Sircana G, Milano G (2015) Magnetic resonance imaging criteria for the assessment of the rotator cuff after repair: a systematic review. Knee Surg Sports Traumatol Arthrosc 23(2):423–442

    PubMed  Google Scholar 

  36. Saito M, Tsukada S, Fujita N, Rahman M, Morita W, Kitamura N, Tasaki A (2018) Post-operative pain control following arthroscopic rotator cuff repair: peri-articular injection versus interscalene brachial plexus block. Int Orthop. https://doi.org/10.1007/s00264-018-4096-3

    Article  PubMed  Google Scholar 

  37. Shin SJ, Do NH, Lee J, Ko YW (2016) Efficacy of a Subacromial Corticosteroid Injection for Persistent Pain After Arthroscopic Rotator Cuff Repair. Am J Sports Med 44(9):2231–2236

    PubMed  Google Scholar 

  38. Spielmann AL, Forster BB, Kokan P, Hawkins RH, Janzen DL (1999) Shoulder after rotator cuff repair: MR imaging findings in asymptomatic individuals–initial experience. Radiology 213(3):705–708

    CAS  PubMed  Google Scholar 

  39. Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 21(11):1307–1316

    PubMed  Google Scholar 

  40. Warner JJ, Higgins L, Parsons IMT, Dowdy P (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elb Surg 10(1):37–46

    CAS  Google Scholar 

  41. Williams BT, Redlich NJ, Mickschl DJ, Grindel SI (2019) Influence of preoperative opioid use on postoperative outcomes and opioid use after arthroscopic rotator cuff repair. J Shoulder Elb Surg 28(3):453–460

    Google Scholar 

  42. Willinger L, Lacheta L, Beitzel K, Buchmann S, Woertler K, Imhoff AB, Scheiderer B (2018) Clinical outcomes, tendon integrity, and shoulder strength after revision rotator cuff reconstruction: a minimum 2 years' follow-up. Am J Sports Med 46(11):2700–2706

    PubMed  Google Scholar 

  43. Xu C, Zhao J, Li D (2014) Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears. J Shoulder Elb Surg 23(2):182–188

    Google Scholar 

  44. Zanetti M, Jost B, Hodler J, Gerber C (2000) MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects. Skelet Radiol 29(6):314–319

    CAS  Google Scholar 

Download references

Funding

This study was supported by Shanghai Sports Science and Technology "Comprehensive Plan" Project (18Z004).

Author information

Authors and Affiliations

  1. Department of Sports Medicine, Huashan Hospital, No 12, Wulumuqi Zhong Road, Shanghai, 200040, People’s Republic of China

    Hong Li, Yuzhou Chen & Shiyi Chen

Authors
  1. Hong Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuzhou Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiyi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shiyi Chen.

Ethics declarations

Conflict of interest

The authors report no conflict of interest.

Ethical approval

The study was approved by the Health Sciences Institutional Review Board of Huashan Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Written consent was obtained from all participants.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, H., Chen, Y. & Chen, S. Postoperative residual pain is associated with a high magnetic resonance imaging (MRI)-based signal intensity of the repaired supraspinatus tendon. Knee Surg Sports Traumatol Arthrosc 27, 4014–4020 (2019). https://doi.org/10.1007/s00167-019-05651-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-019-05651-8

Keywords

Search

Navigation