POST-OPERATIVE IMAGING of the Shoulder MRI

Anatomic repair of the labrum and capsule using metallic suture anchors is being increasingly employed in glenohumeral instability using an arthroscopic approach[28]. On post-operative MR imaging, susceptibility artifacts

Normal post-operative appearance after arthroscopic suture-anchor repair of Bankart lesion. Oblique sagittal (A) and axial (B) T2-weighted TSE fat-suppressed image reveals the three suture-anchors in place (arrows). No fluid is seen between the labral margin and the opposed labrum and joint capsule.

(Figure ​ from the metallic implants may degrade the image quality. A few important points should be kept in mind to overcome this problem: gradient echo sequences should be avoided and replaced by spin echo sequences when possible; fast spin echoes are preferable over standard spin echo sequences; and inversion recovery sequences should be preferred over chemical fat suppression. After an anatomic apposition of the labrum to the articular margin in suture-anchor repair, no hyperintensity should be visible between the two. MR arthrography is more useful in post-operative shoulders as a problem solving tool in suspected recurrent labral tear. Contrast-enhanced T1W sequences should always be acquired in addition if there is a suspicion of septic arthritis[29].

Non-anatomic repairs (Putti-Platt repair, Bristow-Helfet procedure) are usually not preferred for primary instability surgery. Following capsular shift or shrinkage procedures, thickening of the joint capsule can be visualized on imaging.

Complications during arthroscopic repair include inadvertent injury to the axillary nerve (lying in close relation to the inferior joint capsule) and subscapularis muscle injury, hematoma, infection, septic arthritis, heterotopic ossification.