Evaluating Elastographic Tendon Stiffness as a Predictor of Return to Work and Sports After Primary Rotator Cuff Repair.

Abstract

Background: Despite many patients not returning to their preoperative levels of work and sports after primary rotator cuff repair, few studies have investigated the association between findings on postoperative imaging and patients returning to work and sports. Shear wave elastography ultrasound (SWEUS) is a recent technology that quantifies the stiffness of healing repaired cuff tendons.

Hypothesis: Stiffer repaired cuff tendons that reflect improved healing would be associated with improved return to work and sports.

Study design: Cohort study; Level of evidence, 2.

Methods: This was a prospective cohort study of 50 patients undergoing primary arthroscopic rotator cuff repair. Preoperatively, all patients completed a questionnaire ranking their level of sports and work activity on a 4-point Likert scale. At 8 days, 6 weeks, 12 weeks, 6 months, and 1 year postoperatively, patients reported their current levels of sports and work on the same scale and had SWEUS stiffness measurements taken at 3 points along their repaired tendons.

Results: The elastographic stiffness of supraspinatus tendons at their repaired insertion sites increased by a mean of 22% over 12 months (P = .0001). Elevated supraspinatus tendon stiffness at 6 weeks and 12 weeks was associated with return to sports at 12 months (r = 0.46; P = .003 and r = 0.39; P = .01), and tendon stiffness at 12 weeks and 6 months was associated with return to work at 12 months (r = 0.49; P = .001 and r = 0.46; P = .003). Patients returning to sports (r = 0.46; P = .003) and work (r = 0.49; P = .001) were most strongly associated with SWEUS stiffness 12 weeks after cuff repair.

Conclusion: The elastographic stiffness of a healing repaired supraspinatus tendon is moderately associated with improved return to work and sports 12 months after rotator cuff repair. Tendon stiffness at 12 weeks postrepair was the most critical timepoint in predicting both return to work and sports at 12 months postrepair.