title: In vivo visualization of vascular patterns of rotator cuff tears using contrast-enhanced ultrasound.
abstract: BACKGROUND
  Hypoxia and decreased blood supply have been proposed as risks for tendon rupture. Visualization of the vascularity of intact and torn rotator cuffs would be useful for improving treatments for rotator cuff tear.
  
  
  OBJECTIVE
  To assess vascularity inside a tendon or an adjacent rotator cuff insertion point in patients differing in age and extent of damage to the tendon.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Ten volunteers (all men) and 15 patients (10 men, 5 women) consented to participate in the study. Contrast agent for enhanced ultrasound was injected intravenously. Enhanced ultrasound images of the torn cuff and the contralateral shoulder were recorded for 1 minute. Four small regions of interest, the articular and bursal sides of the tendon and the medial and lateral sides of the bursa, were studied in all shoulders.
  
  
  RESULTS
  There was a significant decrease in blood flow in the intratendinous region in elderly subjects compared with young subjects, but age had no effect on blood flow in bursal tissue. Blood flow in ruptured rotator cuffs did not differ from that in intact rotator cuffs. The intraclass correlation coefficient for intraobserver reproducibility was 0.82 (95% confidence interval: 0.77-0.86).
  
  
  CONCLUSIONS
  The findings of this investigation were the hypovascular pattern in intratendinous tissue compared with the subacromial bursa, the age-related decrease in intratendinous vascularity, and the hypovascular pattern in the tendon, regardless of rupture of the tendon. Clarification of vascular patterns inside or around the torn ends of a rotator cuff will assist in the development of successful treatments for torn rotator cuffs.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan. tfunakoshi@gmail.com
authors.forename: Tadanao
authors.initials: T
authors.lastname: Funakoshi
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kamishima
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Nishida
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ito
authors.forename: Makoto
authors.initials: M
authors.lastname: Kondo
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001265:Athletic Injuries / Q000000981:diagnostic imaging* / Q000473:pathology; D016001:Confidence Intervals; D003287:Contrast Media; D003430:Cross-Sectional Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017006:Rotator Cuff / Q000098:blood supply / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D013708:Tendon Injuries / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D003287:Contrast Media