title: In vivo vascularity alterations in repaired rotator cuffs determined by contrast-enhanced ultrasound.
abstract: BACKGROUND
  The alterations in blood flow after rotator cuff repair remain unclear. Visualization of vascular patterns could clarify basic and clinical investigations.
  
  
  OBJECTIVE
  To assess longitudinal blood flow inside the repaired cuff and the surrounding tissue after rotator cuff repair, using contrast-enhanced ultrasonography.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Fifteen patients (7 men and 8 women; mean age, 65.0 ± 9.8 years) consented to participate. The patients underwent an ultrasound scan before and 1, 2, and 3 months after surgery. Enhanced ultrasound images were recorded for 1 minute after intravenous injection of contrast reagent. Four regions of interest inside the cuff and 2 regions in the anchor hole and subacromial bursa were superimposed on the obtained images. Calculated areas under the time-intensity curves were expressed in acoustic units (AU).
  
  
  RESULTS
  We found area-dependent differences in patterns of alteration and magnitude of blood flow inside the repaired cuff and peritendinous tissues. Vascularity in the articular distal and bursal distal region of the repaired cuff at 1 month postoperatively increased significantly compared with that at the preoperative baseline (76 vs 5 AU, P = .0037; 92 vs 7 AU, P = .043). The vascularity peaked at 1 month after surgery in the bursal area within the cuff but at 2 months in the articular area. The vascularity in the articular proximal region of the repaired cuff was significantly lower than that in the bursal proximal (P = .0046), bursal distal (P = .0183), and articular distal regions (P = .0163) 1 month after surgery.
  
  
  CONCLUSIONS
  Enhancement patterns in intratendinous tissue increased at 1 or 2 months postoperatively and decreased at 3 months. We found area-dependent differences in enhancement patterns inside the repaired cuff and peritendinous tissue.
  
  
  CONCLUSIONS
  Visualization of vascularization using contrast-enhanced ultrasound could help in deciding on an appropriate repair technique or on the form of postoperative rehabilitation after rotator cuff repair.
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University School of Medicine, 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: Kinya
authors.initials: K
authors.lastname: Nishida
authors.forename: Makoto
authors.initials: M
authors.lastname: Motomiya
authors.forename: Naoki
authors.initials: N
authors.lastname: Suenaga
authors.forename: Akio
authors.initials: A
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000601:surgery; D003287:Contrast Media; D005260:Female; D005290:Ferric Compounds; D006801:Humans; D007501:Iron; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic; D010087:Oxides; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D017006:Rotator Cuff / Q000098:blood supply* / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005290:Ferric Compounds; D010087:Oxides; C069727:Sonazoid; D007501:Iron