title: Contrast-enhanced ultrasound characterization of the vascularity of the repaired rotator cuff tendon: short-term and intermediate-term follow-up.
abstract: BACKGROUND
  The objectives of this study were to characterize and compare the vascularity of arthroscopically repaired rotator cuff tendons at short-term and intermediate-term follow-up.
  
  
  METHODS
  Nineteen patients who underwent arthroscopic rotator cuff repair were prospectively monitored for an average of 21.2 months. Initial baseline, grayscale ultrasound images of the operated-on shoulder were obtained on all patients at 3 months and at a minimum of 10 months postoperatively. Perflutren-lipid microsphere contrast (DEFINITY, Lantheus Medical Imaging, North Billerica, MA, USA) was injected after baseline grayscale images and after exercise to obtain contrast-enhanced images of the repair. Three regions of interest--supraspinatus tendon, peribursal tissue, and bone anchor site--were evaluated before and after rotator cuff-specific exercises.
  
  
  RESULTS
  The peribursal tissue demonstrated the greatest blood flow, followed by the bone anchor site and tendon, in pre-exercise and postexercise states. Significantly less blood flow was observed in all regions of interest before exercise (P < .05) and only at the bone anchor site after exercise (P < .001) at latest follow-up compared with the 3-month values. Intratendinous blood flow remained relatively low at both evaluation points after surgical repair.
  
  
  CONCLUSIONS
  Preliminary findings suggest that the peribursal tissue and bone anchor site are the main conduits of blood flow for the rotator cuff tendon after arthroscopic repair, with the supraspinatus tendon being relatively avascular. Blood flow of the repaired rotator cuff tendon decreases with time. Furthermore, exercise significantly enhances blood flow to the repaired rotator cuff.
authors.affiliation: Shoulder and Sports Medicine Service, Hospital for Special Surgery, New York, NY 10021, USA. ec2195@columbia.edu
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Cadet
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Adler
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gallo
authors.forename: Seth C
authors.initials: SC
authors.lastname: Gamradt
authors.forename: Russell F
authors.initials: RF
authors.lastname: Warren
authors.forename: Frank A
authors.initials: FA
authors.lastname: Cordasco
authors.forename: Stephen
authors.initials: S
authors.lastname: Fealy
mesh_terms: D001182:Arthroscopy; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D017006:Rotator Cuff / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000601:surgery; D012785:Shoulder Joint / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014463:Ultrasonography
chemical_list: D003287:Contrast Media