Shear-wave elastography may predict success of rotator cuff surgery: Study
The findings indicate the complementary role of preoperative shear-wave elastography as a prognostic marker in patients with rotator cuff tears.
South Korea: Preoperative use of shear-wave elastography (SWE) can predict the success of rotator cuff surgery, according to a recent study published in the American Journal of Roentgenology. The study found that SWE-derived elasticity was higher in patients with insufficient rotator cuff repair; the elasticity ratio is an independent predictor of insufficient repair.
Rotator cuff tears prevalence varies around the world, but it is suggested that it is generally increasing. Such tears cause shoulder pain and dysfunction while the torn muscle shows fatty degeneration and atrophy linked to a loss of elasticity. Accurate evaluation of muscle quality before surgery is required to guide prognostic assessments for a successful repair. MRI is an imaging method used to assess pathology and muscle quality. However, it does not provide information on tensile force or stiffness.
SWE has shown to be promising in musculoskeletal imaging, such as for evaluating pathologies of the supraspinatus tendon of the rotator cuff. Considering this, Jeung Yeol Jeong, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-Do, Republic of Korea, and colleagues aimed to explore the utility of preoperative SWE measurements of the supraspinatus muscle to predict successful rotator cuff repair, including comparison with MRI-based measures in a prospective study.
The study included 74 patients who underwent rotator cuff repair from May 2019 to January 2021. Patients underwent preoperative clinical shoulder MRI and investigational shoulder ultrasound including SWE using shear modulus. Mean elasticity of the supraspinatus and trapezius muscles was measured. The elasticity ratio between supraspinatus and trapezius mean elasticity was calculated.
Grayscale ultrasound was used to record muscular fatty infiltration score (1-3 scale). Goutallier's grade (0-4 scale) was used to assess muscular fatty infiltration on MRI, and muscular atrophy was assessed by the occupation ratio (ratio between cross-sectional areas of supraspinatus muscle and supraspinatus fossa) and by muscle atrophy grade (0-3 scale). Following the repair, the surgeon classified procedures as achieving sufficient (n=60) or insufficient (n=14) repair.
Following were the key findings of the study:
- Patients with insufficient, versus sufficient, repair more commonly exhibited a large (3-5 cm) tear (100.0% vs 50.0%).
- Patients with insufficient, versus sufficient, repair exhibited higher mean Goutallier's grade (3.8±0.4 vs 1.9±1.1), mean muscle atrophy grade (2.0±0.8 vs 0.5±0.7), mean supraspinatus elasticity (44.15±8.06 vs 30.84±7.89 kPa), elasticity ratio (3.66±0.66 vs 1.83±0.58), and grayscale fatty infiltration grade (2.9±0.4 vs 1.6±0.7), and lower occupation ratio (0.3±0.1 vs 0.6±0.1).
- AUC for predicting insufficient repair was 0.945 for Goutallier's grade, 0.961 for occupation ratio, 0.900 for muscle atrophy grade, 0.874 for mean elasticity, 0.971 for elasticity ratio, and 0.912 for grayscale fatty infiltration grade.
- Elasticity ratio (cutoff ≥2.51) achieved a sensitivity of 100.0% and specificity of 90.0% for insufficient repair.
- At multivariable analysis including tear size, the three MRI measures, elasticity ratio, and grayscale fatty infiltration grade, only independent predictors of insufficient repair were muscle atrophy grade of 2-3 (odds ratio=9.3) and elasticity ratio (odds ratio=15.6).
"The findings showed that SWE-derived elasticity is higher in patients with insufficient rotator cuff repair; elasticity ratio independently predicts insufficient repair," wrote the authors. This implies that preoperative SWE may serve as a prognostic marker in patients with rotator cuff tears.
Reference:
American Journal of Roentgenology: -. 10.2214/AJR.21.27129
