Preoperative Increases in T2-Weighted Fat-Suppressed Magnetic Resonance Imaging Signal Intensities Associated With Advanced Tissue Degeneration and Mitochondrial Dysfunction in Rotator Cuff Tears

Abstract

PurposeThe purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) signal intensities and mitochondrial function in patients undergoing arthroscopic rotator cuff repair, assessed through histological and genetic profiling of tendon tissue. MethodsThis study, conducted between April 2022 and January 2023, included 20 patients undergoing rotator cuff repair for atraumatic/degenerative tears. Rotator cuff tendon edge samples were obtained during arthroscopic rotator cuff repair. Patients were classified based on signal intensity from preoperative T2-weighted fat suppressed MRI. Specifically, they were categorized as having either high or low signal intensity at the rotator cuff tendon edge, with the deltoid muscle serving as a reference. Comparative analyses specifically compared the histological features and genetic profiles of the tendon tissue at the rotator cuff tendon edge. Histological evaluation of harvested tendon specimens during arthroscopic rotator cuff repair employed the modified Bonar score. Real-time polymerase chain reaction was used to assess expression of various mitochondrial and apoptosis-related genes. The mitochondrial morphology of the rotator cuff torn site was examined using electron microscopy. ResultsThe higher signal intensity group showed significantly higher modified Bonar scores (p=0.0068), decreased mitochondrial gene expression, increased TUNEL-positive cells (p=0.032), lower SOD activity (p=0.011), reduced ATP5A (p=0.031), and increased cleaved caspase-9 activity (p=0.026) when compared to the lower signal intensity group. Electron microscopy revealed fewer mitochondrial cristae in the higher signal intensity group. ConclusionOur results suggest correlations between high MRI signal intensities and the presence of degeneration, mitochondrial dysfunction, and increased apoptosis in rotator cuff tissues. This underscores the utility of MRI signal intensity as an indicator of tissue condition. Clinical RelevanceBuilding on the established premise that elevated preoperative MRI signal intensities may indicate higher rates of postoperative rotator cuff re-tears, the current study substantiates these findings from a mitochondrial function perspective.