Suzanne S. Long MD, Presenter: Nothing to Disclose

William B. Morrison MD, Abstract Co-Author: Medical Advisory Board, ONI Medical Systems, Inc Medical Advisory Board, General Electric Company Consultant, Apriomed AB

Juan Carlos Narvaez MD, Abstract Co-Author: Nothing to Disclose

Gabrielle Patricia Konin MD, Abstract Co-Author: Nothing to Disclose

Adam C. Zoga MD, Abstract Co-Author: Nothing to Disclose

Uncovered suture anchors are commonly seen with breakdown of labral and rotator cuff repair in our experience. We sought to evaluate this finding as well as other signs in a population of patients with MRI and repeat surgery.

Twenty two shoulders in 21 patients (14M, 7F; age 22-86, avg 51) with rotator cuff repair (N=16) or labral repair (N=6) underwent MR imaging with subsequent surgical follow up. Images were reviewed for uncovered suture anchor, edema or fluid around the anchor, subacromial/subdeltoid bursal fluid, displaced sutures, tissue signal, thickness and irregularity, and fluid extending through the rotator cuff or labrum. Comparison was made with surgical results.

Of the 22 shoulders, there were 5 intact rotator cuff repairs and 1 intact labral repair. All others were re-torn. Bursal fluid was seen in 4/5 intact rotator cuff repairs and 10/11 re-tears. In 13/16, the bursal fluid was complex. In intact cuff repairs, the tendon was irregular in 5/5; thin in 4/5 and thick in 1/5. In re−tears, the tendon was irregular in 10/11; thick in 2/11, thin in 9/11. Intact cuff repair showed relatively high tendon signal (not equal to fluid) in 2/5 whereas tendon signal was low in 7/11 in re−tears. Communication was seen in 10/11 re−tears and 1/5 intact repairs (size of communication in the intact repair was 7mm). Regarding labral repair, fluid extended under the labrum in 0/1 intact repair, and 3/5 re−tears. Labral irregularity was seen in all cases, intact and retorn. Considering all anchors (cuff and labrum), uncovered anchor was seen in 0/6 intact repairs and 16/16 re−tears. Bone marrow edema around the anchor was seen in 2/6 intact and 9/16 re−tears. Fluid around the anchor was seen in 0/6 intact and 3/16 re−tears. Displaced anchor was seen in 0/4 intact and 1/10 re−tears. Displaced suture was seen in 2/6 intact and 10/16 re−tears. A displaced anchor was seen in 0/6 intact and 1/16 re-tears.

Of all the signs of breakdown of rotator cuff and labral repair, an uncovered anchor appears to be the most specific for recurrent tear.

Failure of rotator cuff and labral repair can be difficult to diagnose on MRI. Uncovering of a suture anchor appears to be specific for repair breakdown.

Long, S, Morrison, W, Narvaez, J, Konin, G, Zoga, A, The Uncovered Anchor Sign: Utility for Diagnosis of Rotator Cuff and Labral Repair Failure.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12043764.html