Trabecular microstructure and surface changes in the greater tuberosity in rotator cuff tears

OBJECTIVE: When planning surgery in patients with rotator cuff tear, strength of bone at the tendon insertion and trabecular bone structure in the greater tuberosity are usually taken into consideration. We investigated radiographic changes in bone structure of the greater tuberosity in rotator cuff tears. DESIGN: Twenty-two human cadaveric shoulders from subjects ranging from 55 to 75 years of age were obtained. The integrity of the rotator cuff was examined by sonography to determine if it is intact without any tear, or torn partially or completely. The humeral head was sectioned in 3 mm thick coronal slab sections and microradiographed. After digitization of the microradiographs and imaging processing with in-house semi-automated image processing software tools developed using software interfaces on a Sun workstation, the trabecular histomorphometrical structural parameters and connectivity in the greater tuberosity were quantified. The degenerative changes on the surface of the greater tuberosity were interpreted blindly by 2 independent readers. RESULTS: Among the 22 shoulder specimens, the rotator cuff was found intact in 10 shoulders, partially in 7 and fully torn in 5. Statistically significant loss in apparent trabecular bone volume fraction, number of trabecular nodes, and number of trabecular branches, and a statistically significant increase in apparent trabecular separation and number of trabecular free ends were found in the greater tuberosity of the shoulders with tears. The loss was greater in association with full tear than in partial tear. Thickening of the cortical margin of the enthesis, irregularity of its surface, and calcification beyond the tidemark were observed in 2 (20%) shoulders with intact rotator cuff, in 6 (86%) shoulders with partial tear, and in 5 (100%) shoulders with full tear. CONCLUSIONS: Rotator cuff tears are associated with degenerative changes on the bone surface and with disuse osteopenia of the greater tuberosity. Aging, degenerative enthesopathy of the supraspinatus tendon, and rotator cuff tears appear closely related.     

Interobserver agreement in the classification of rotator cuff tears

BACKGROUND: Six classification systems have been proposed for describing rotator cuff tears designed to help understand their natural history and make treatment decisions. PURPOSE: To assess the interobserver variation for these classification systems and identify the method with the best interobserver agreement. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Six rotator cuff tear classification systems were identified in a literature search. The components of these systems included partial-thickness rotator cuff tears and classification by size, shape, configuration, number of tendons involved, and by extent, topography, and nature of the biceps. Twelve fellowship-trained orthopaedic surgeons who each perform at least 30 rotator cuff repairs per year reviewed arthroscopy videos from 30 patients with a random assortment of rotator cuff tears and classified them by the 6 classification systems. Interobserver variation was determined by a kappa analysis. RESULTS: Interobserver agreement was high when distinguishing between full-thickness and partial-thickness tears (0.95, kappa = 0.85). The investigators agreed on the side (articular vs bursal) of involvement for partial-thickness tears (observed agreement 0.92, kappa = 0.85) but could not agree when classifying the depth of the partial-thickness tear (observed agreement 0.49, kappa = 0.19). The best agreement for full-thickness tears was seen when the tear was classified by topography (degree of retraction) in the frontal plane (observed agreement 0.70, kappa = 0.54). CONCLUSION: With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. Researchers should consider describing full-thickness rotator cuff tears by topography (degree of retraction) in the frontal plane.     

The partial-thickness rotator cuff tear: is acromioplasty without repair sufficient?

We evaluated the clinical outcome of arthroscopic acromioplasty and debridement in 162 patients who had either normal rotator cuffs, grade 1 (frayed tendon) partial-thickness tears, or grade 2 (less than 50% of the tendon) partial-thickness tears. The mean time from surgery to the response to the L'Insalata outcome questionnaire was 52.7 months (4.5 years) among the 105 respondents (107 shoulders). The mean score was 90 points; eight patients (8%) scored less than 70 points (range, 30 to 65.5), and their treatment failed early on. The patients with grade 2B (bursal) partial-thickness rotator cuff tears had a significantly higher failure rate (38%). Although the clinical outcome of patients with partial-thickness tears of the rotator cuff comprising less than 50% of the tendon (grade 1 and 2) was not significantly different from that of patients without partial rotator cuff tears, the subgroup of patients with grade 2B partial tears had a statistically significantly higher failure rate and may have been better served with primary repair. With follow-up to 10 years, there was no evidence that clinically relevant or symptomatic intrinsic rotator cuff pathologic conditions progress in those patients with partial-thickness tears treated with arthroscopic anterior acromioplasty.     

Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis

PURPOSE: To determine which US signs are important in the diagnosis of a surgically identifiable supraspinatus tendon tear. MATERIALS AND METHODS: Fifty consecutive ultrasonographic (US) studies of the shoulder in patients who underwent arthroscopic follow-up were retrospectively reviewed by a musculoskeletal radiologist. US images of the supraspinatus tendon were evaluated for tendon nonvisualization, abnormal tendon echogenicity, tendon thinning, greater tuberosity cortical irregularity, cartilage interface sign, joint fluid, and subacromial-subdeltoid bursal fluid. US findings were compared with arthroscopic results. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for each US sign in the diagnosis of full-thickness tendon tear and again for any type of supraspinatus tendon tear. RESULTS: Arthroscopy revealed 21 full-thickness tears, five bursal surface partial-thickness tears, 10 articular surface partial-thickness tears, and 14 patients without tear of the supraspinatus tendon. The presence of greater tuberosity cortical irregularity and joint fluid was most important in the diagnosis of full-thickness supraspinatus tendon tear (sensitivity, 60%; specificity, 100%; positive predictive value, 100%; negative predictive value, 78%; accuracy, 84%). For diagnosis of any type of supraspinatus tendon tear (partial or full thickness), tendon nonvisualization, greater tuberosity cortical irregularity, and cartilage interface sign are most important, although a combination of signs did not improve accuracy. CONCLUSION: Secondary US signs, such as greater tuberosity cortical irregularity and joint fluid, are most valuable in the diagnosis of supraspinatus tendon tear.     

Humeral head cysts and rotator cuff tears: an MR arthrographic study

Objective Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age.Design and patients Shoulder MR arthrograms were reviewed in 120 consecutive patients—83 males (mean age 38.0, range 19–59 years) and 37 females (mean age 41.2, range 15–59 years). Patients were referred for investigation of a variety of conditions, and instability was suspected in only a minority of cases. MR was performed before and after direct arthrography with 0.01% solution of gadolinium. Cysts were defined as well-demarcated circular/ovoid foci in two planes that demonstrated high signal on pre-arthrographic T2W sequences. Location, size and numbers of cysts and post-arthrographic enhancement were documented, along with the location of rotator cuff tears, if present.Results Cysts in the tuberosities of the humerus were identified in 84 patients (70%), and were seen seven times more frequently in the posterior aspect of the greater tuberosity than anteriorly. Most cysts (94%) demonstrated communication with the joint post-arthrogram. Rotator cuff tears were present in 36 patients, and 79% of all tears occurred in supraspinatus tendon. There was no significant difference in the occurrence of cysts between patients older or younger than age 40 or between genders, but rotator cuff tears were seen significantly more often in the older age group (p<0.01). Tuberosity cysts and rotator cuff tears did not appear to be related (p=0.55). However, whilst this lack of association was quite obvious posteriorly (p=0.84), the trend in the anterior aspect of the greater tuberosity is not as clear (p=0.14).Conclusions Humeral cysts are most often located in the posterior aspect of the greater tuberosity, communicate with the joint space and, in this location, are not related to aging or rotator cuff tear.An erratum to this article can be found at     

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

Purpose

To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears.

Materials and methods

Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery.

Results

Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively.

Conclusions

In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears.     

Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques

BACKGROUND: Interface contact pressure between the tendon and bone has been shown to influence healing. This study evaluates the interface pressure of the rotator cuff tendon to the greater tuberosity for different rotator cuff repair techniques. HYPOTHESIS: The transosseous tunnel rotator cuff repair technique provides larger pressure distributions over a defined insertion footprint than do suture anchor techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Simulated rotator cuff tears over a 1 x 2-cm infraspinatus insertion footprint were created in 25 bovine shoulders. A transosseous tunnel simple suture technique (n = 8), suture anchor simple technique (n = 9), and suture anchor mattress technique (n = 8) were used for repair. Pressurized contact areas and mean pressures of the repaired tendon against the tuberosity were determined using pressure-sensitive film placed between the tendon and the tuberosity. RESULTS: The mean contact area between the tendon and tuberosity insertion footprint was significantly greater for the transosseous technique (67.7 +/- 5.8 mm(2)) compared with the suture anchor simple (34.1 +/- 9.4 mm(2)) and suture anchor mattress (26.0 +/- 5.3 mm(2)) techniques (P < .05). The mean interface pressure exerted over the footprint by the tendon was also greater for the transosseous technique (0.32 +/- 0.05 MPa) compared with the suture anchor simple (0.26 +/- 0.04 MPa) and suture anchor mattress (0.24 +/- 0.02 MPa) techniques (P < .05). CONCLUSION: The transosseous tunnel rotator cuff repair technique creates significantly more contact and greater overall pressure distribution over a defined footprint when compared with suture anchor techniques. CLINICAL RELEVANCE: Stronger and faster rotator cuff healing may be expected when beneficial pressure distributions exist between the repaired rotator cuff and its insertion footprint. Tendon-to-tuberosity pressure and contact characteristics should be considered in the development of improved open and arthroscopic rotator cuff repair techniques.     

MR imaging of shoulder injuries in professional baseball players.

Magnetic resonance (MR) imaging was used to evaluate the shoulders of 10 symptomatic professional baseball players and one asymptomatic player, with surgical correlation in six cases and arthrographic correlation in two cases. Seven small rotator cuff tears measuring 0.5-1 cm were identified on MR images, with arthrographic and surgical confirmation of these findings in two patients and surgical confirmation only in three patients. Cortical irregularity and/or subchondral cyst formation at the posterior aspect of the greater tuberosity near the insertion site of the infraspinatus tendon was found in five of the seven players with rotator cuff tears. Similar findings were noted in the asymptomatic volunteer and in one of the three players without cuff tear, who also had irregular thickening of the posterior capsule. These findings are believed to represent chronic avulsive changes resulting from the deceleration stresses of the follow-through motion.     

Intra-articular repair of an isolated partial articular-surface tear of the subscapularis tendon

BACKGROUND: Partial-thickness tear of the subscapularis tendon in the articular surface is common. HYPOTHESIS: Intra-articular repair of a partial articular-surface tear of the subscapularis tendon will provide a successful outcome. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 29 shoulders with an isolated partial articular-surface tear of the subscapularis tendon without another rotator cuff lesion were treated with arthroscopic intra-articular repair using suture anchors. Biceps tenodesis was performed in 16 patients. Outcomes were prospectively evaluated at a mean of 27 months (range, 19-41 months) using 3 objective (University of California at Los Angeles, American Shoulder and Elbow Surgeons Shoulder Index, Simple Shoulder Test) and 2 subjective (pain and function visual analog scales) measurements. RESULTS: There were 21 men and 8 women, with a mean age of 54 years (range, 41-65 years). Tear widths were small (<1 cm) in 16 shoulders and large (>1 cm) in 13 shoulders. Twenty-six shoulders had articular cartilage erosion on the adjacent humeral head. Lesions of the biceps tendon were noted in 25 patients (partial tear in 15 shoulders; subluxation in 13 shoulders). Shoulder pain scores improved after surgery (5.0 +/- 2.7 to 0.3 +/- 0.7, P < .05). According to American Shoulder and Elbow Surgeons Shoulder Index scores, 18 were excellent; 10, good; and 1, fair. Internal rotation strength deficit improved from 32% to 4%. Twenty-six patients returned to more than 90% of previous activity. There were no surgical complications; tear size and biceps tenodesis did not affect outcome (P > .05). CONCLUSION: Arthroscopic intra-articular repair of a partial articular-surface tear of the subscapularis tendon is an effective procedure that spares the intact tendon attachment in the bursal surface. Short-term outcomes were reliable by both objective and subjective measurements.     

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as centered in the anterior or posterior half of the cuff, and as either in the critical zone or adjacent to the bony insertion. The original MR interpretation was compared with the arthroscopic findings. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years)(P=0.23). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56 (P=0.17). The average age of the 9 patients with rim-rent tears was 31 years, while that of the 28 patients with similarly-sized partial tears not involving the insertion was 40 years old (P=0.048). Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity for these tears is lower than in recent articles, we found no significant difference between the sensitivity of MR for diagnosing posterior tears versus tears in the anterior half of the supraspinatus tendon. Rim-rent tears can be mistaken for intratendinous signal, and should be carefully looked for in younger patients with shoulder pain.     

肩袖损伤的影像学及关节镜诊疗价值

目的探讨肩袖损伤的影像学改变及关节镜检查在诊疗中的价值。方法18例肩袖损伤术前行造影和磁共振成像(MRI)。关节镜手术18例，其中关节镜下肩峰成形减压术16例，小切口肩峰成形2例。全层肩袖损伤10例行小切口肩袖缝合，肩袖部分磨损8例行关节镜下刨削清理术。结果肩关节造影13例，其中9例显示肩关节腔与肩峰下滑囊和三角肌下滑囊沟通，4例未见异常。MRI检查18例，其中10例显示肩袖全层损伤，8例冈上肌腱信号异常为部分损伤。根据关节镜检查结果判断其诊断准确率，MRI为100％，肩关节造影69％。术后随访时间3～22个月，平均7个月。根据美国加州洛杉矶大学(UCLA)肩关节评分标准，优9例，良6例，可3例，优良率达83％。结论肩关节造影有助于全层肩袖损伤的诊断；MRI对肩袖部分和全层损伤正确诊断率和敏感性最高；关节镜治疗肩袖损伤具有微创，有利于功能恢复。     

Tendon-bone interface motion in transosseous suture and suture anchor rotator cuff repair techniques

BACKGROUND: Although many studies involving rotator cuff repair fixation have focused on ultimate fixation strength and ability to restore the tendon's native footprint, no studies have characterized the stability of the repair with regard to motion between the tendon and repair site footprint. HYPOTHESIS: Suture anchor fixation for rotator cuff repair has greater interface motion between tendon and bone than does transosseous suture fixation. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve fresh-frozen human cadaveric shoulders were tested in a custom device to position the shoulder in internal and external rotations with simulated supraspinatus muscle loading. Tendon motion relative to the insertional footprint on the greater tuberosity was determined optically using a digital camera rigidly connected to the humerus, with the humerus positioned at 60 degrees of internal rotation and 60 degrees of external rotation. Testing was performed for the intact tendon, a complete supraspinatus tear, a suture anchor repair, and a transosseous tunnel repair. RESULTS: Difference in tendon-bone interface motion when compared with the intact tendon was 7.14 +/- 3.72 mm for the torn rotator cuff condition, 2.35 +/- 1.26 mm for the suture anchor repair, and 0.02 +/- 1.18 mm for the transosseous suture repair. The transosseous suture repair demonstrated significantly less motion when compared with the torn rotator cuff and suture anchor repair conditions (P < .05). CONCLUSION: Transosseous suture repair compared with suture anchor repair demonstrated superior tendon fixation with reduced motion at the tendon-to-tuberosity interface. CLINICAL RELEVANCE: Development of new fixation techniques for arthroscopic and open rotator cuff repairs should attempt to minimize interface motion of the tendon relative to the tuberosity.     

Greater tuberosity notch: an important indicator of articular-side partial rotator cuff tears in the shoulders of throwing athletes.

We examined the location of rotator cuff tears, associated labral injuries, and notches on the greater tuberosity of the humeral head in shoulders of throwing athletes. Arthroscopic findings (rotator cuff tear, labral condition, and greater tuberosity notch) as well as other factors (duration of playing baseball, range of motion, and joint laxity) of 61 baseball players were retrospectively studied. The presence of a greater tuberosity notch was also evaluated for by plain radiographs. Forty patients had articular-side partial rotator cuff tears, most of which occurred in the interval between the supraspinatus and infraspinatus tendons. The existence of a rotator cuff tear was not related to the range of motion, joint laxity, the detachment of the superior glenoid labrum, or posterosuperior labral injury. Greater tuberosity notches were recognized in 38 shoulders by arthroscopy and most were detected on plain radiographs. The presence of a notch was significantly related to the existence of a rotator cuff tear, while the size of the notch was significantly related to the depth and width of the tear. The greater tuberosity notch seems to be one of the most important diagnostic indicators for a rotator cuff tear in throwing athletes.     

肱骨大结节囊性变发生率与肩袖撕裂的关系

目的:探讨肱骨大结节囊性变发生率与肩袖撕裂之间的关系。方法:回顾性总结了2006年至2008年于北京大学第三医院运动医学研究所接受肩关节镜治疗的肩袖撕裂患者74名和复发性脱位患者71名,分别为肩袖撕裂组和复发性脱位组。测量患者MRI及X线片上显示的囊性变的最大直径,并且使用X线片评估大结节及肩峰的硬化、增生情况及形态。结果:所有患者中,39.3%患者的MRI中发现有囊性变。肩袖撕裂组,60.8%患者的MRI显示有囊性变,44.6%患者的MRI及X线片同时显示有囊性变。复发性脱位组,16.9%患者的MRI显示有囊性变,8.5%患者的MRI及X线片同时可见囊性变。肩袖撕裂患者中,有囊性变的患者平均病史23个月(7天-20年),未发现囊性变的患者平均病史26.8个月(1-120个月)。X线片显示,肱骨大结节囊性变及局限性密度减低,同时伴有III型肩峰及大结节增生硬化的患者均为肩袖撕裂患者。结论:肩袖撕裂患者出现肱骨大结节囊性变的比例明显高于无肩袖损伤患者,囊性变发生率与病史无明显相关。     

Repair of full-thickness rotator cuff tears in professional baseball players

BACKGROUND: Despite the relative frequency of partial-thickness rotator cuff tears seen in baseball players, full-thickness rotator cuff tears in baseball players are uncommon. HYPOTHESIS: Return to competitive baseball is difficult after surgical treatment of a full-thickness rotator cuff tear. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We evaluated the results of 16 professional baseball players after a mini-open repair of a full-thickness rotator cuff tear. Twelve patients were pitchers with injury to their dominant shoulders. Four patients were position players; 2 had injuries involving their dominant shoulders, and 2 had injuries to their nondominant shoulders. RESULTS: At a mean follow-up of 66.6 months for the pitchers, only 1 player (8%) was able to return to a high competitive level of baseball with no significant shoulder dysfunction after mini-open repair of a full-thickness rotator cuff tear. Of the 2 position players with mini-open repairs of the full-thickness rotator cuff tear of their dominant shoulders, 1 was able to return to professional baseball. Of the 2 position players with mini-open repairs of the full-thickness rotator cuff tear of their nondominant shoulders, both were able to return to professional baseball at the same or higher level. CONCLUSION: It is very difficult for a professional baseball pitcher to return to a competitive level of pitching after a full-thickness rotator cuff repair with a mini-open approach.     

Gadolinium MR Arthrography of the Rotator Cuff

Conventional magnetic resonance imaging (MRI) of the rotator cuff has not done well in distinguishing partial-thickness tears from tendonitis or small, full-thickness tears. However, these are important distinctions for orthopedic surgeons who are deciding whether to operate and what type of surgery to perform on a patient with suspect rotator cuff pathology. Gadolinium magnetic resonance arthrography (MRA) involves injecting dilute gadolinium into the shoulder under fluoroscopy. Subsequent multiplanar T1-weighted fat-suppressed fast spin echo combined with T2-weighted fast spin echo and short tau inversion recovery (STIR) produces images that can accurately differentiate absence of tear from partial-thickness tear and from small, full-thickness tear; as a fringe benefit, this combination of sequences can identify the inflammation associated with tendonitis. Furthermore, the technique differentiates articular from bursal surface partial-thickness tears, and it accurately quantitates the size of full-thickness tears to help surgeons choose between arthroscopic versus open surgery.     

Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors

OBJECTIVE: The purpose of this study was to analyze the causes of errors in the detection and measurement of rotator cuff tears in our patient population. SUBJECTS AND METHODS: Seventy-one consecutive patients with shoulder pain who were prospectively studied with sonography had subsequent arthroscopy that showed a full-thickness or partial-thickness tear or intact cuff. For sonography and arthroscopy, the length or degree of retraction and width of a tear, when present, was recorded. When there were discrepant findings, representative images were jointly evaluated by the radiologist and orthopedic surgeon to determine the cause of the error. RESULTS: Fifteen detection errors were found, including five misses (three < 5-mm subscapularis and two small partial-thickness tears), four errors inherent with the test (distinguishing large bursal side or extensive partial-thickness from full-thickness tears and tendinopathy from partial-thickness tears), three errors of an unknown cause, two due to misinterpretation, and one error inherent with the patient. Seventeen measurement errors occurred with full-thickness tears, 15 of those in patients with large or massive tears. Bursal thickening (n = 4), non-visualization of the torn tendon end (n = 2), nonretracted tear (n = 2), and complex tear (n = 1) contributed to the errors. Eight measurement errors occurred with partial-thickness tears. Difficulty distinguishing tendinopathy from partial-thickness tears (n = 3) and complex tears (n = 3) accounted for six errors. CONCLUSION: Although infrequent, detection errors were due to limitations inherent with the test or misses. Limitations inherent with the patient and misinterpretation of the findings were rare. Most measurement errors occurred in patients with large or massive cuff tears.     

Patterns of vascular and anatomical response after rotator cuff repair

BACKGROUND: It has been assumed that a robust vascular response at the tendon to bone interface during rotator cuff repairs is an integral part to the healing process. There are few studies that have explored this in an in-vivo prospective fashion. PURPOSE: To prospectively characterize vascular and anatomical patterns in repaired rotator cuff tendons using Power Doppler sonography in a double-blinded fashion. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Fifty patients undergoing rotator cuff repair were enrolled: 28 mini-open, 14 open, and 8 arthroscopic repairs; 20 patients were controls. Patients underwent Power Doppler sonography at 6 weeks, 3 months, and 6 months postoperatively. Power Doppler sonography analysis examined 6 areas of the rotator cuff repair: discretely marginated intrasubstance, partial-thickness defects, full-thickness defects, focal thinning of repair, presence of bursal or joint fluid, and location of anchors. A subjective scoring system assessed blood flow in each region. RESULTS: There was a predictable, significant decrease in vascular scores after rotator cuff repair over time. The mean vascular score was 11.6 at 6 weeks, 8.3 at 3 months, 7.0 at 6 months, and 2.4 for controls. There was a significant difference (P < .05) in vascular recruitment scores between each time period, with the most robust flow at the peritendinous region. The lowest vascular score was at the anchor site or cancellous trough. Forty-eight percent of the patients had a rotator cuff repair defect postoperatively. These findings did not correlate with functional assessment and outcome at 6 months. There was no significant difference in vascular scores between the defect and no-defect groups. Mean University of California, Los Angeles; L'Insalata; and American Shoulder and Elbow Surgeons scores at 6 months were 28.6, 86.3, and 81.5, respectively. Thirty-three percent of asymptomatic controls had a rotator cuff tear that averaged 7.6 x 7.1 mm. CONCLUSION: The robust vascular response dropped with time, which is not seen in asymptomatic shoulders. Nearly half of the patients demonstrated persistent rotator cuff defects after rotator cuff repair that did not correlate with functional outcome and physical findings at 6 months.