Magnetic resonance arthrography (MRA) in the postoperative shoulder

To evaluate changes in capsular mechanisms and the labroligamentous complex with magnetic resonance arthrography (MRA) after shoulder surgery and to establish possible criteria for the expected post-operative appearance of the shoulder. MRA of the shoulder was performed in 16 patients, before and 6 months after undergoing arthroscopic surgery for recurrent unidirectional dislocation. MR studies were performed after application of a constant amount of contrast solution (2 mmol Gd-DTPA). Axial and coronal oblique T1-weighted images were obtained with and without fat suppression techniques. Anterior (a) and posterior (p) capsular distances were measured, and the p/a ratio was established. Capsule thickness, capsular leaking, estimation of the volume of the axillary recess, appearance of the glenohumeral ligaments, and evidence of labral lesions were compared on pre- and postoperative images. Mean anterior capsular distance (a) decreased from 9.73 +/- 1.03 mm preoperatively to 5.27 +/- 2.49 mm postoperatively, whereas dorsal capsular distance (p) increased from 6.13 +/- 2.36 to 8.93 +/- 2.37. The p/a ratio increased from 0.64 +/- 0.25 to 2.36 +/- 2.54 (p = 0.007). Capsular leaking was suspected preoperatively in seven patients, but was not evident postoperatively. Capsular thickness and the estimated volume in the axillary recess did not change significantly. Contrast extension into pre-existent labral tears (nine patients) decreased or were not evident postoperatively. Changes in the appearance of the glenohumeral ligaments were found in six patients. Changes in capsular distances might be indicative of a decreased capsular laxity and could be a valuable criterion in the evaluation of the postoperative shoulder. Postoperative follow-up of labral tears is demonstrated by a decrease in contrast extension into or under a tear. Reactive capsular thickening or scar tissue formation can be reactive or preexistent. Changes in ligaments might be secondary to surgery. MRA may be helpful in the reevaluation of patients with suspected recurrent instability.