Successful revision rotator cuff repair starts with a thorough preoperative evaluation. Accurate imaging and clinical assessment provide critical details about tendon quality, muscle health, bone structure, and the presence of any previous surgical hardware. This information guides surgical planning and helps predict outcomes.
The Role of Clinical Evaluation
- Detailed History: Review prior surgeries, rehabilitation efforts, and current symptoms.
- Physical Examination: Assess range of motion, strength, and signs of instability or impingement.
- Functional Goals: Discuss patient activity level, occupation, and return-to-sport expectations.
Imaging Modalities in Revision Cases
Magnetic Resonance Imaging (MRI)
- Primary Use: Visualizes tendon integrity, retraction, muscle atrophy, and fatty infiltration.
- Strengths: Excellent soft tissue contrast; can detect subtle re-tears and associated labral or biceps pathology.
- Considerations: Metal anchors from prior surgery may create artifact—MRI sequences can be adjusted to reduce this.
Computed Tomography (CT)
- Primary Use: Best for evaluating bone structure, anchor position, and glenoid or humeral head changes.
- Strengths: 3D reconstructions assist in planning complex anchor removal or bone grafting.
- Considerations: Often paired with MRI for complete assessment in revision cases.
Ultrasound
- Primary Use: Dynamic assessment of cuff integrity and tendon motion; useful for quick, office-based evaluation.
- Strengths: No radiation, cost-effective, real-time imaging.
- Considerations: Operator-dependent; may be less accurate for deep tissue visualization.
Integrating Imaging into Surgical Planning
- Tissue Quality: MRI findings of severe fatty infiltration or muscle atrophy may shift the plan toward graft augmentation or tendon transfer.
- Hardware Review: CT identifies the type, location, and condition of previous anchors or screws.
- Defect Mapping: Imaging helps determine if there is significant bone loss requiring augmentation.
Summary Table
| Imaging Modality | Strengths | Limitations |
| MRI | Best for soft tissue, tendon health | Metal artifact, higher cost |
| CT | Best for bone and hardware assessment | Radiation exposure |
| Ultrasound | Dynamic, portable, cost-effective | Operator-dependent, limited deep visualization |
Frequently Asked Questions
1. Do I need all three imaging types before surgery?
Not always—MRI is the most common, but CT and ultrasound are used selectively based on findings.
2. Can MRI show if my tendon will heal?
MRI can estimate tissue quality, but healing also depends on biological and patient factors.
3. Why is CT important in revision surgery?
It helps map existing hardware and assess bone health, which are critical for planning anchor placement.
4. Is ultrasound reliable for diagnosing re-tears?
Yes, in experienced hands, but deep or complex tears may require MRI confirmation.
5. How soon before surgery should imaging be done?
Typically within 3–6 months to ensure accurate, up-to-date information.
