The Effect of Tendon Delamination on Rotator Cuff Healing

2019 ◽  
Vol 47 (5) ◽  
pp. 1074-1081 ◽  
Author(s):  
Pascal Boileau ◽  
Olivier Andreani ◽  
Martin Schramm ◽  
Mohammed Baba ◽  
Hugo Barret ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Tendon Healing ◽  
Type A ◽  
Rotator Cuff Tears ◽  
Type B ◽  
Partial Coverage ◽  
Type C ◽  
Cuff Repair ◽  
Tear Size

Background: While patient age, tear size, and muscle fatty infiltration are factors known to affect the rate of tendon healing after rotator cuff repair, the effect of tendon delamination is less known. Purpose: To assess the effect of tendon delamination on rotator cuff healing after arthroscopic single-row (SR) repair. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients (N = 117) with chronic full-thickness rotator cuff tears underwent arthroscopic SR repair with the tension-band cuff repair. The mean ± SD age at the time of surgery was 60 ± 8 years. There were 25 small, 63 medium, and 29 large tears. Tendon delamination was assessed intraoperatively under arthroscopy with the arthroscope placed in the lateral portal. Patients were divided into 2 groups: those with nondelaminated (n = 80) and delaminated (n = 37) cuff tears. The 2 groups were comparable for age, sex, body mass index, preoperative pain, strength, and a Constant-Murley score. Repair integrity was evaluated with sonography (mean, 24 months after surgery; range, 6-62 months) and classified into 3 categories: type A, indicating complete, homogeneous, and thick coverage of the footprint; type B, partial coverage with a thin tendon; and type C, no coverage of the footprint. Results: The prevalence of tendon delamination observed under arthroscopy was 32% (37 of 117), which increased with tear size and retraction: from 15% in small tears to 32% in medium tears and 45% in large tears ( P = .028). Postoperatively, 83 patients had complete coverage of footprint (type A = 71%) and the cuff was considered healed, whereas 26 had partial coverage or a thin tendon (type B = 22%) and 8 had no coverage (type C = 7%). Overall, the rate of complete healing was 78% in nondelaminated cuff tears and 57% in the case of tendon delamination ( P = .029). In large retracted tears, the healing rate dropped from 81% in the absence of delamination to 39% when the tendons were delaminated ( P = .027). Conclusion: Tendon delamination increases with tear size and retraction. Patients with chronic delaminated and retracted rotator cuff tears (stage 2 or 3) are at risk of failure after SR cuff repair, whereas patients with small delaminated rotator cuff tears (stage 1) involving only the supraspinatus can be treated with an SR cuff repair with a high chance of tendon healing. These results suggest that SR cuff repair may be insufficient to treat delaminated chronic cuff tears. To improve the anatomic outcomes of rotator cuff repairs, surgeons should consider treating delaminated tears with a double-row or double-layer repair.

Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases

2019 ◽  
Vol 47 (3) ◽  
pp. 674-681 ◽  
Author(s):  
Jieun Kwon ◽  
Ye Hyun Lee ◽  
Sae Hoon Kim ◽  
Jung Hoon Ko ◽  
Byung Kyu Park ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Infiltration ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Symptom Duration ◽  
Negative Prognostic Factor ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. Purpose: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. Results: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older ( P < .001) and had longer symptom duration ( P = .019), larger tear sizes and retractions ( P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality ( P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. Conclusion: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.

scholarly journals The Effect of Time Interval from MRI to Rotator Cuff Repair on Tear Size: Imaged vs. Actual Tear Size

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Amanda J. Naylor ◽  
Michael D. Charles ◽  
Allison Jamie Rao ◽  
Gregory Louis Cvetanovich ◽  
Michael C. O’Brien ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Critical Time ◽  
T Test ◽  
Rotator Cuff Tears ◽  
Time Interval ◽  
Consecutive Series ◽  
Full Thickness ◽  
Cuff Repair ◽  
Tear Size

Objectives: Magnetic resonance imaging (MRI) is the advanced imaging modality of choice for the evaluation and diagnosis of full thickness rotator cuff tears (RCT). Tear size progression has been correlated with increasing pain. However, there is little data on tear size progression in symptomatic RCT with regard to time from MRI to actual rotator cuff repair (RCR). The purpose of the study was to evaluate the effect of time (from date of MRI measured tear dimensions to date of RCR measured intraoperative tear dimensions) on tear size progression. Methods: In the course of a study on physical examination manual muscle tests in patients with known full thickness RCT requiring repair, MRI was obtained for each patient undergoing RCR. Tears were measured intraoperatively in the Anterior-Posterior (A-P) and Medial-Lateral (M-L) dimensions with a graduated probe. Location (anterior, central, posterior in the supraspinatus tendon), area of the tear, and anterior band of supraspinatus status (intact/ not intact) were recorded.The preoperative MRI was evaluated by the same examiner blinded to the operative results at least 4 weeks after the RCR and the same parameters measured.There were 64 consecutive shoulders with 40 male, 24 female at an average age of 58 yrs (40-76) that had MRI and underwent RCR. The mean MRI dimensions were: A-P tear:16.53 mm (SD 9.70); M-L tear: 17.3 mm (SD 9.75); Tear area: 366.7 square mm. The average time from preoperative MRI to RCR was 107.3 days (range 12-399 days). Operative mean RCT dimensions were: A-P tear: 18.38 mm (SD 10.0); M-L tear: 14.06 mm (SD 8.15); Tear area: 307.7 square mm.Descriptive statistical analysis with two-sample T-test was performed to determine the temporal effect on tear size from date of MRI to the date of surgery, and whether there was a change.Patients were grouped in the following time cohorts based on the length of time elapsed between the preoperative MRI and date of RCR: ≤1 month, 1 month to 2 months, 2 months to 3 months, 3 months to 9 months, and ≥9 months. The delta, or difference between intraoperative measurements and preoperative MRI measurements, was calculated for each cohort. Results: The t-test revealed a significant time effect with regard to tear size between the MRI and the intraoperative measured tear requiring repair. This was significant for the A-P dimension (p<0.001), the Medial-Lateral dimension (p<0.001), and the total area of the tear (p=0.009). In an attempt to determine a “watershed” or critical time interval where MRI and RCT size correlated, an additional analysis was performed. The change in A-P tear dimension between MRI and RCR findings showed increasing delta with increasing time. Positive mean delta in A-P dimension was seen in the 2-3 month group (2.64), with larger differences seen in the 3 month to 9 month (5.89) and ≥9 month (7.3) groups. A similar trend was seen for mean delta values in the M-L dimension among the cohorts. Conclusion: In a consecutive series of RCTs undergoing repair, the measured MRI dimensions and the intraoperative dimensions were recorded and analyzed. A surgeon can have a level of confidence that the RCT size will correlate with MRI tear size within a certain time frame. There is a significant effect of time on tear size progression from MRI dimensions to actual RCT dimensions at time of repair.

scholarly journals Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

2016 ◽  
Vol 10 (1) ◽  
pp. 286-295 ◽  
Author(s):  
William R. Mook ◽  
Joshua A. Greenspoon ◽  
Peter J. Millett
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Surgical Techniques ◽  
Tendon Healing ◽  
Senior Author ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Single Row ◽  
Increased Risk ◽  
Cuff Repair

Background: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. Methods: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. Results: The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Conclusion: Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

Effect of Smoking on Healing Failure After Rotator Cuff Repair

2018 ◽  
Vol 46 (12) ◽  
pp. 2960-2968 ◽  
Author(s):  
Jung Ho Park ◽  
Kyung-Soo Oh ◽  
Tae Min Kim ◽  
Jayoun Kim ◽  
Jong Pil Yoon ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Fatty Infiltration ◽  
Outcome Evaluation ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Smoking History ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair ◽  
Heavy Smokers

Background: No study to date has directly evaluated rotator cuff repair results among smokers. Purpose: To evaluate whether smoking affects healing after arthroscopic rotator cuff repair through propensity score matching (PSM). Study Design: Cohort study; Level of evidence, 3. Methods: Among 249 patients who underwent arthroscopic repair of full-thickness rotator cuff tears, 34 current heavy smokers were selected with a smoking history >20 pack-years (mean ± SD pack-years, 33.91 ± 12.13). Characteristics between current heavy smokers and nonsmokers were compared. According to the PSM technique, 34 nonsmokers were selected after 1:1 matching for age, fatty infiltration, and tear size—the main prognostic factors of outcomes after rotator cuff repair. Each patient’s outcome evaluation was completed anatomically at a minimum of 6 months (magnetic resonance imaging or ultrasonography) and functionally at a minimum of 1 year (pain visual analog scale, range of motion, American Shoulder and Elbow Surgeons, Constant, University of California, Los Angeles, and Simple Shoulder Test scores), and every outcome was analyzed in the matched smoker and nonsmoker groups. Results: Current heavy smokers had a higher incidence of male sex ( P < .001), heavy manual work ( P = .025), high bone density ( P = .036), and poor tendinosis grade ( P = .028). After adjustment for the confounding variables by PSM, the matched smoker group showed a significantly higher healing failure rate than the matched nonsmoker group (29.4% vs 5.9%, P = .023). However, we failed to detect significant differences in the functional outcomes between the matched groups ( P > .05). Conclusion: Smoking affected healing failure after arthroscopic rotator cuff repair. Attention should be paid to smokers, especially current heavy smokers, in cases of rotator cuff repair surgery.

scholarly journals Rotator cuff tears: functional outcomes of open surgery

2020 ◽  
Author(s):  
Zafer Volkan Gokce
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Tendon Healing ◽  
The Elderly ◽  
Rotator Cuff Tears ◽  
Functional Assessments ◽  
Before And After ◽  
Correlation Tests ◽  
Cuff Repair

Abstract Background: The aim of the present study was to evaluate the clinical and radiological outcomes of the patients who underwent open surgical repair with the diagnosis of rotator cuff rupture. Methods: Twenty-eight rotator cuff tear patients refractory to conservative treatment and underwent open rotator cuff repair between April 2012 and April 2017 were retrospectively included in the study. Patients were assessed radiologically and clinically before and after surgery. Patients' age, gender, duration of complaints, the type of the rupture, the data obtained during operation (rupture size, shape, affected tendon, the presence of retraction if any), postoperative complications were recorded. Functional assessments of the patients were performed at 6th and 12th months preoperatively and postoperatively with objective assessments using Constant and UCLA scoring. All patients' operated shoulders were evaluated with MRI during their recent follow-up. Results: The mean postoperative follow-up period of the patients was 30.4 (range: 13-72) months. Preoperative and postoperative mean UCLA scores of the patients were 10.85±1.89, and 28.8±3.34, respectively (p < 0.001). Pre-, and postoperative average Constant scores were 38.1 (range, 7.0 to 56.0), and 72.4 (range, 52.0 to 98.0), respectively (p < 0.001). Rotator cuff continuity was assessed in shoulder MRIs obtained during recent follow-ups of patients, and four recurrent tears were observed. Correlation tests revealed that tear size observed during surgery showed a significant (p = 0.002) and a weakly negative (r = -0.468) correlation with preoperative Constant scores, and a significant (p = 0.0001) and moderately negative (r = -0.645) relationship with postoperative Constant scores. UCLA and Constant functional outcomes were worse in patients over 60 years of age, than younger patients and recurrent tears were more often observed in the elderly population. A significant relationship was revealed between the age of the patients and tendon healing (p < 0.05). Conclusion: The results of this study suggest that open repair is a reasonable and successful treatment option in patients with rotator cuff tears. Overall satisfactory clinical outcomes could be achieved.

scholarly journals Non-Operative Management of Rotator Cuff Tears

2016 ◽  
Vol 10 (1) ◽  
pp. 349-356 ◽  
Author(s):  
M. Petri ◽  
M. Ettinger ◽  
S. Brand ◽  
T. Stuebig ◽  
C. Krettek ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Tendon Repair ◽  
Operative Management ◽  
Nonoperative Treatment ◽  
Rotator Cuff Tears ◽  
Patient Counseling ◽  
Non Operative Management ◽  
Tear Size ◽  
Over Time

Background: The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a progression of tear size and fatty muscle infiltration over time, with however debatable clinical relevance for the patient. Suggested factors associated with progression of a rotator cuff tear are an age of 60 years or older, full-thickness tears, and fatty infiltration of the rotator cuff muscles at the time of initial diagnosis. Conclusion: Non-operative management is indicated for patients with lower functional demands and moderate symptoms, and/or of course for those refusing to have surgery. Close routinely monitoring regarding development of tear size should be performed, especially in patients that remain symptomatic during nonoperative treatment. To ensure judicious patient counseling, it has to be taken into account that 1) tears that are initially graded as reparable may become irreparable over time, and 2) results after secondary surgical therapy after failed nonoperative treatment are usually reported to be inferior to those who underwent primary tendon repair.

scholarly journals A Novel Reparability Assessment Scoring System for Full-Thickness Rotator Cuff Tears

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094097
Author(s):  
In Park ◽  
Jun-Seok Kang ◽  
Hye-Ah Lee ◽  
Yoon-Geol Jo ◽  
Sang-Jin Shin
Keyword(s):  
Rotator Cuff ◽  
Constant Score ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Assessment Score ◽  
Tendon Length ◽  
Complete Repair ◽  
Tear Size

Background: It is difficult to predict the arthroscopic reparability of rotator cuff tears preoperatively when the repair is challenging. This can result in unsatisfactory outcomes and a high retear rate. Purpose: To develop an assessment score reflecting factors in rotator cuff tears that can predict reparability before surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively enrolled 170 patients with rotator cuff tears larger than 2 cm who underwent arthroscopic repair. Patients were categorized into “complete repair” and “partial repair” groups based on the area of the exposed footprint after arthroscopic rotator cuff repair. In each group, preoperative magnetic resonance imaging factors (tear size, fatty infiltration, remnant tendon length, atrophy), clinical factors (range of motion, American Shoulder and Elbow Surgeons score, Constant score), and patient demographics were evaluated. Receiver operating characteristic curve analysis was used to choose the optimal cutoff value. A reparability assessment score was formulated through stepwise selection using variables that showed significant between-group differences on univariate analysis. We selected 4 variables and assigned a relative score for each variable based on estimated coefficient values. The sum of the scores for each factor ranged from 0 to 5. Results: The average rotator cuff tear size was 28 × 26 mm. The torn rotator cuff was repaired completely in 74 patients (43.5%) and partially in 96 patients (56.5%). The following factors were chosen for the reparability assessment score: positive tangent sign (odds ratio [OR], 5.969; P = .001), fatty infiltration of the infraspinatus of grade ≤2 (OR, 3.537; P = .001), coronal tear size ≥26 mm (OR, 3.315; P = .002), and remnant tendon length <15 mm (OR, 2.584; P = .017). Complete repair was possible if the sum of the scores was <3 (area under curve, 0.803; 95% CI, 0.739-0.867; sensitivity, 51.0%; specificity, 95.9%). Conclusion: In patients with a score of <3 on the novel reparability assessment score, complete repair was obtainable, whereas in patients with a score of ≥3, complete repair was difficult and other methods such as biologic grafts or arthroplasty had to be considered for a favorable prognosis.

Diagnostic value of the axial view of magnetic resonance imaging to identify two-dimensional shapes of full-thickness rotator cuff tears

2020 ◽  
Vol 61 (11) ◽  
pp. 1545-1552
Author(s):  
Sung-Weon Jung ◽  
Jin-Woo Jin ◽  
Dong-Hee Kim ◽  
Hyeon-Soo Kim ◽  
Gwang-Eun Lee ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rotator Cuff ◽  
Rotator Cuff Tear ◽  
Fatty Infiltration ◽  
Rotator Cuff Tears ◽  
Two Dimensional ◽  
Resonance Imaging ◽  
Cuff Tear ◽  
Tear Size

Background Coronal and sagittal views of magnetic resonance imaging (MRI) were used to determine rotator cuff tear size and fatty infiltration, but these images were not enough to identify the tear shape. Purpose To correlate the preoperative axial MRI views and arthroscopic surgical findings to identify the two-dimensional shapes in rotator cuff tears. Material and Methods This study included 166 patients who underwent arthroscopic repair between 2015 and 2018. Preoperative coronal, sagittal, and axial MRI views were evaluated for tear size and geographic configuration in axial sections, and the length and the width were measured and were matched with arthroscopic surgical views by lateral portals. Results The agreement of axial MRI views with the arthroscopic view was 88.0% in crescent, 97.2% in longitudinal, 78.6% in massive, and 100% in rotator cuff tear arthropathy. The mean agreement rate of axial MRI views with arthroscopic view was 81.9%. Mean mediolateral and anteroposterior tear sizes on axial MRI were 16.68 mm and 19.33 mm, respectively. Mean mediolateral and anteroposterior tear sizes by arthroscopic view were 21.49 mm and 21.04 mm, respectively. Tear sizes by MRI axial images were 71.3% of arthroscopic view. SST/IST degenerative changes were noted in most patients with massive tears and rotator cuff arthropathy ( P = 0.001). Conclusion Rotator cuff tear shape on preoperative axial MRI view had close agreement (81.9%) with arthroscopic findings by lateral portal, and tear size by preoperative axial MRI views was 71.3% of that of arthroscopic view. Axial MRI views helped to predict the geometric tear shape of rotator cuff tears.

scholarly journals Pre-Operative Quantitative MRI-Based Rotator Cuff Muscle Fat Fractions Are Associated with Patient-Reported Outcomes Following Rotator Cuff Repair

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Drew A. Lansdown ◽  
Cyrus Morrison ◽  
Musa Zaid ◽  
Rina Patel ◽  
Alan L. Zhang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Fatty Infiltration ◽  
Intramuscular Fat ◽  
Muscle Quality ◽  
Patient Reported ◽  
Fat Fraction ◽  
Cuff Repair ◽  
Tear Size

Objectives: Advanced fatty infiltration is correlated with poor outcomes after rotator cuff repair, and high-grade fatty infiltration is considered a contraindication for repair. The influence of lower levels of fatty infiltration on outcomes after rotator cuff repair remains unclear. Quantitative magnetic resonance (MR) imaging sequences, specifically IDEAL imaging (iterative decomposition of water and fat with echo asymmetry and least-squares estimation), has been recently applied to measuring fatty infiltration of the rotator cuff muscles. Our purpose was to evaluate the relationship between rotator cuff intramuscular fat and patient-reported outcome measures after rotator cuff repair. We hypothesized that higher pre-operative fat content would be negatively correlated with post-operative outcomes. Methods: We retrospectively identified patients who underwent arthroscopic rotator cuff repair with pre-operative MRI scan with sagittal-oblique IDEAL imaging. All procedures were approved by our Institutional Review Board. Pre-operative tear size, tendon involvement, and tendon retraction were measured by a musculoskeletal radiologist. Image segmentation was performed manually on four consecutive slices with perimuscular fat excluded. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity computer adapted survey at a minimum of two years after repair. Correlations between intramuscular fat measurements and PROMIS scores were determined with Spearman’s rank correlation coefficient. Patients were grouped by PROMIS scores above and below 50, as 50 represents population mean. Mann-Whitney U tests were used to compare fat fractions between patients with high PROMIS scores (at or above 50) or low PROMIS scores (less than 50). Multivariate linear regression was performed with PROMIS score as the dependent variable, and individual muscle fat fractions, age, BMI, sex, and total tear size as independent predictors. Significance was defined as p<0.05. Results: A total of 80 patients were included (Table 1). Mean follow-up was 42.5 ±10.7 months. Post-operative PROMIS scores were significantly correlated with the infraspinatus fat fraction (rho = -0.25, p = 0.02) and subscapularis fat fraction (rho = -0.29, p = 0.009). The infraspinatus fat fraction for patients with a low PROMIS score (N=31) was significantly higher relative to those with a PROMIS score above 50 (N=49) (7.2±4.9% vs. 5.2 ±3.0%; p=0.046) (Figure 1). The subscapularis fat fraction was significantly higher for patients with a low PROMIS score relative to those with a PROMIS score above 50 (10.4 ±5.1% vs. 8.2 ±5.0%; p=0.001). In controlling for age, BMI, sex, and total tear size, multivariate regression modeling identified infraspinatus fat fraction (beta = -0.68, p = 0.029) as the only significant independent predictor of post-operative PROMIS score. Conclusion: We observed significant relationships between infraspinatus and subscapularis muscle quality and post-operative patient-reported outcomes after rotator cuff repair. Infraspinatus fat fraction was the only significant predictor when accounting for demographics and rotator cuff tear size. Importantly, these patients were selected for rotator cuff repair and therefore excluded patients with advanced fatty infiltration. Even in patients with lower degrees of muscle degeneration, small differences in muscle quality may impact outcomes after tendon repair. [Table: see text][Figure: see text]

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