Shoulder: Rotator Cuff Repair

Postoperative imaging of the rotator cuff remains challenging despite accumulated years of experience and technical advancements in both MRI and ultrasound. Both MRI and ultrasound are highly effective imaging modalities for evaluating a repaired rotator cuff tendon for potential re-tear. The early postoperative period (less than 6 months) remains the most challenging period for imaging evaluation given the persistence of normal changes seen caused by the surgery itself. Those changes often dissipate with time. Serial imaging is very helpful to evaluate for re-tears after a new injury or new symptom development. The diagnosis of a tendon re-tear should rely on the unequivocal identification of a tendon defect rather than simply heterogeneity or small cleft. Small tendon defects may disappear over time and fill in with granulation tissue. Equivocal imaging findings of the rotator cuff after repair should be followed up serially to determine their clinical significance.