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Findings The initial radiograph shows prior rotator cuff repair with retear and a high riding humeral head. The MR images of 3/2016 show the complete disruption of the supraspinatus(SST) with marked medial retraction and a now irreparable cuff tear. The infraspinatus (IST)and subscapularis(SS) tendons are intact. Subsequent MR imaging of 6/2016 demonstrates a low signal band of tissue (on all pulse sequences) which extends underneath the acromion to the greater tuberosity but does not reach the glenoid. At its posterior margin, the low signal tissue merges with the intact IST tendon.
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Diagnosis: Superior Capsular Reconstruction Disruption The low signal band of tissue shown in this case is a dermal allograft which is utilized to perform a superior capsular reconstruction (SCR). First performed utilizing a fascia lata graft it is now performed with a dermal allograft. The procedure is performed in the setting of an irreparable rotator cuff tear of the SST or SST/IST in patients without advanced arthritis, a functioning deltoid, and an intact or reparable SS tear. As part of the technique, the graft has multiple fixation sites at the glenoid and the tuberosity but in between the areas of fixation the graft sits at the glenoid and the tuberosity. Additional fixation is also performed of the graft to the IST tendon or muscle to prevent humeral head subluxation. The spot of graft failure has been studied in the literature although with most case series being small. The sites of potential graft failure are at the glenoid, midsubstance, the greater tuberosity, the fixation to the IST, or at multiple locations (global failure). Some reports have had greater failure at the tuberosity, but many others including one of my colleague’s investigations had greater failure at the glenoid. Although midsubstance failures seem to be the least prevalent, the important point is to be aware that failure can occur at multiple locations. Special thanks to Tate Greditzer, MD for his assistance in the preparation of this case presentation.
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References Magnetic Resonance Imaging of the Failed Superior Capsular Reconstruction. Christopher P Emerson, George C Balazs, Susan C Lee, Joshua S Dines, Jean Jose, Harry G Greditzer 4th. Clin Imaging. 2020 Apr;60(2):172-176. doi: 10.1016/j.clinimag.2019.10.006. Epub 2019 Nov 13. Superior Capsular Reconstruction. Indications, Techniques, and Clinical Outcomes. Frank, Rachel M. MD; Cvetanovich, Gregory MD; Savin, David MD; Romeo, Anthony A. MD. JBJS Reviews: July 2018 - Volume 6 - Issue 7 p e10 doi: 10.2106/JBJS.RVW.17.00141.
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