Current imaging of the cuff are exploring the tear of the tendon and the quality of muscle. Tractography, an imaging used in neurology, can identify functional unit in nerve disorders. Using tractography, a modelization of the tendon muscle unit, we explore its accuracy in the diagnosis of cuff tear and its organization.

Increase predictability of cuff repair.

Fifty-nine patients were prospectively involved in the current study. Patients underwent a tractography (performed in a MRI device) just before shoulder arthroscopy. During surgery, size of the tear, type of tear (U, L reverse, L or other), orientation of reduction and reparability were collected. Tractographies were analyzed assessing the presence of a tear, the orientation of the tendon fibers, the global aspect of the tear.

Twenty-five women and 34 men were involved for a cuff repair. Twenty-seven cuffs were U shape, 9 L shape, 9 reverse L shape, one was superficial and one was deep side tear, and 11 were tendinopathy. Five cases were massive tears. In 10 cases, it was not possible to totally reduce the cuff. Inter- and intraobserver correlation was total. Tractography systematically identify the tear of the tendon. It demonstrates disorganization of tendons in tendinopathy. It identifies U, L or reverse L tears by viewing fibers organization, systematically corresponding to what was performed during surgery.

Tractography of the cuff, a modelization allowing to reconstruct tendon fiber organization, is a reproducible imaging acquisition allowing to better understand the shape of the tendon, and should be used to improve selection of patients for cuff tear repair.