Is it expected to see a large full‑thickness supraspinatus tear with retraction and partial‑thickness tears of the infraspinatus and articular‑side supraspinatus on MRI eight weeks after rotator‑cuff repair?

Post-Rotator Cuff Repair MRI Findings at 8 Weeks

No, these MRI findings are NOT expected at 8 weeks post-repair and represent surgical failure requiring urgent orthopedic re-evaluation. A large full-thickness supraspinatus tear with retraction and partial-thickness infraspinatus tears at this timepoint indicate either technical failure of the initial repair or an early retear, both of which demand immediate surgical consultation to determine if revision surgery is indicated.

Understanding the Timeline of Rotator Cuff Repair Failure

The critical window for retears extends from 6 to 26 weeks post-operatively, with the majority occurring during this period rather than in the immediate postoperative phase 1. Specifically:

• Retears demonstrate a linear increase over the first 26 weeks after arthroscopic rotator cuff repair, with mean time to failure at 19.2 weeks 1
• The period between 12 and 26 weeks represents the highest risk interval for repair failure, though substantial numbers of retears do occur between 6-12 weeks 1
• Few additional tears occur after 26 weeks postoperatively 1

At 8 weeks post-repair, your patient falls within the early failure window, making these findings particularly concerning for either inadequate initial repair or early biomechanical failure.

What Normal Post-Operative MRI Should Show

A successfully repaired rotator cuff at 8 weeks should demonstrate:

• Intact tendon continuity from the humeral head insertion site without fluid-filled defects 1
• Progressive healing without retraction of the supraspinatus tendon 2
• No new or persistent full-thickness tears 3

The presence of a large full-thickness tear with retraction directly contradicts expected healing and indicates the repair has failed 1.

Clinical Significance of These Specific Findings

Large Full-Thickness Supraspinatus Tear with Retraction

• This represents complete failure of the surgical repair 2, 1
• Retraction indicates the tendon has pulled away from its bony insertion, a finding associated with irreparability and poor prognosis 4
• Healed repairs demonstrate superior patient-reported and functional outcomes compared to unhealed repairs, making this finding prognostically significant 5

Partial-Thickness Infraspinatus Tears

• These may represent either inadequate initial repair of multi-tendon pathology or propagation of the primary tear 6
• MRI has high sensitivity and specificity for full-thickness tears but lower sensitivity for partial-thickness tears, meaning these findings are likely real rather than imaging artifacts 2

Immediate Management Steps

1. Urgent Orthopedic Referral

Contact the operating surgeon immediately with these MRI findings 5. The patient requires:

• Clinical re-examination to correlate imaging with symptoms
• Assessment of strength, range of motion, and functional limitations 3
• Discussion of revision surgery options versus conservative management

2. Factors Influencing Revision Surgery Decision

The surgeon will consider:

• Patient age: Advanced age is strongly linked to increased failure rates and poorer outcomes after rotator cuff repair 5
• Comorbidities: Diabetes mellitus and tobacco use are moderately associated with less favorable postoperative results 5
• Tear characteristics: Medial-lateral tear size, tendon retraction beyond the glenoid, and fatty infiltration predict irreparability 4

3. Imaging Considerations

MR arthrography provides superior detection of partial-thickness tears compared to standard MRI 2, 5. If surgical planning requires more detailed assessment of the infraspinatus partial tears, consider:

• MR arthrography for better visualization of articular-surface partial tears 2, 5
• Evaluation of fatty infiltration and muscle atrophy, which guide surgical decision-making 2, 4

Common Pitfalls to Avoid

• Do not assume these are "normal postoperative changes" – full-thickness tears with retraction at 8 weeks represent failure 1, 3
• Do not delay orthopedic consultation – the 6-26 week window is when intervention can still be considered 1
• Do not order additional imaging without surgical input – the operating surgeon should direct further workup 2
• Avoid attributing symptoms solely to "expected postoperative pain" – retears correlate with persistent pain and dysfunction 3

Prognosis Without Intervention

If these findings are not addressed:

• Full-thickness tears in patients over 60 years demonstrate 54% progression rate with nonoperative management 6
• Fatty infiltration (if present) is significantly associated with tear progression 6
• Only 37% of patients report excellent results with conservative management of symptomatic full-thickness tears, compared to 81% with successful surgical treatment 5