The fate of hypoechoic cleft

Hypoechoic clefts are small defects found on ultrasonographs in the intact rotator cuff tendon after rotator cuff repair. Little is known about the fate of these hypoechoic clefts, as to whether they will heal, persist, or develop into a retear.

This prospective study involved 24 patients who underwent arthroscopic rotator cuff repair surgery and were found to have a hypoechoic cleft at the 6-month postoperative ultrasonograph. A subsequent ultrasonography follow-up was performed at 9 months or later by the same ultrasonographer and the repair re-examined.

At an average postoperative follow-up of 21 months, 14 of the 25 hypoechoic clefts (56%) had healed; 5 (20%) had persistent clefts whereas 6 (24%) had progressed to a full-thickness rotator cuff retear. Patients with a hypoechoic cleft ≥36 mm² were 5 times more likely to have a retear than patients with hypoechoic cleft <36 mm² (relative risk = 5.1; P < .05). Patients with hypoechoic clefts ≥36 mm² had a higher frequency of pain during activity and sleep and a lower level of satisfaction at the 21-month follow-up compared to those with small hypoechoic clefts (P = .05).

This is the first study to evaluate the natural history of a hypoechoic cleft found at ultrasonography following rotator cuff repair. The study showed that clefts less than 36 mm² are likely to heal, while those greater than 36 mm² are at high risk of progressing to full-thickness retears.