Deciphering Unexpected Vascular Locations of Scedosporium spp. and Lomentospora prolificans Fungal Infections, France.

Scedosporium spp. and Lomentospora prolificans are emerging non-Aspergillus filamentous fungi. The Scedosporiosis/lomentosporiosis Observational Study we previously conducted reported frequent fungal vascular involvement, including aortitis and peripheral arteritis. For this article, we reviewed 7 cases of Scedosporium spp. and L. prolificans arteritis from the Scedosporiosis/lomentosporiosis Observational Study and 13 cases from published literature. Underlying immunosuppression was reported in 70% (14/20) of case-patients, mainly those who had solid organ transplants (10/14). Osteoarticular localization of infection was observed in 50% (10/20) of cases; infections were frequently (7/10) contiguous with vascular infection sites. Scedosporium spp./Lomentospora prolificans infections were diagnosed in 9 of 20 patients ≈3 months after completing treatment for nonvascular scedosporiosis/lomentosporiosis. Aneurysms were found in 8/11 aortitis and 6/10 peripheral arteritis cases. Invasive fungal disease--related deaths were high (12/18 [67%]). The vascular tropism of Scedosporium spp. and L. prolificans indicates vascular imaging, such as computed tomography angiography, is needed to manage infections, especially for osteoarticular locations.

Occurrence of focal myositis during Behçet's disease: The identification of a specific vasculitis-associated focal myopathy.

AIMS: This study aimed to report the association of focal myositis (FM) and Behçet's disease (BD) and to analyse the main characteristics of such an association. METHODS: This is a retrospective multicentre study of patients with BD and FM (BD + FM+ group) and those without FM (BD - FM+ group). Clinical, laboratory, radiological, pathological, treatment and outcome data were analysed. RESULTS: The BD + FM+ group included 10 patients; the median [interquartile range] age at BD diagnosis was 25 [16-35] years, and at FM diagnosis, it was 30 [26-42] years. The diagnosis of BD preceded FM in the majority of cases (n = 8/10). FM occurrence was associated with BD flare-ups in three cases. The creatine kinase levels remained normal or slightly increased. Histological analyses identified relatively preserved muscle tissue, associated with vasculitis (n = 5/6). All patients required treatment; most patients relapsed (n = 9/10). The BD - FM+ group included 35 patients. A comparison of the groups identified a trend towards a younger median age at diagnosis of FM among those with BD (p = 0.063) and more frequent focal muscle swelling in the BD + FM+ group (p = 0.029). The pathological analysis identified significantly less frequent muscle alterations in the BD + FM+ group (muscle fibre size heterogeneity, p = 0.021; necrosis, p = 0.007; and fibrosis, p = 0.027). BD + FM+ patients had a higher frequency of relapse (p = 0.003) and systematic treatment (p = 0.042). CONCLUSIONS: FM occurring during BD appears to be part of the systemic vasculitis process and presents as a vasculitis-associated focal myopathy with a specific clinico-histological pattern. Patients with this association require long-term follow-up and adapted management. This case series also highlights the need for research on BD diagnostic criteria in cases of FM.

Arthroscopic double-button Latarjet: two-thirds of bone block healed at 90 days.

PURPOSE: The aim of this study was to evaluate the union rate and risk factors for delayed union in the early postoperative period after an arthroscopic Latarjet with double-button fixation. METHOD: In a retrospective study, postoperative CT scans at 3 months were analysed following an arthroscopic Latarjet with double-button fixation used to treat anterior shoulder instability. Healing of the bone block, its position in the sagittal and coronal planes, and the contact area graft/scapula were analysed. RESULTS: Ninety-eight CT scans (98 patients) were included. The rate of healing at 3 months was 63/98 (64%) and four grafts clearly migrated. The position was perfectly flush to the glenoid rim in 67% and under the equator in 96%. The mean contact graft/scapula area was 135 mm 2 (4-420). In multivariate analysis, the risk of non-union at 3 months was associated with tobacco consumption (p = 0.001, aOR = 12.17 95% CI [2.62-56.49]), absence of preoperative glenoid bone defect (p = 0.003, aOR = 8.06 95% CI [2.06-31.56]), and a contact area graft/scapula less than 120 mm 2 (p = 0.010, aOR = 5.25 95% CI [1.50-18.40]). Among 31 non-united grafts, 93% definitively healed on CT scan at 1 year, leaving an overall rate of 93% of united grafts at last follow-up. CONCLUSIONS: The rate of union at 3 months after an arthroscopic Latarjet with double-button fixation was 64%, reaching 93% at 1 year. This procedure should be carefully indicated in case of tobacco use or instability without glenoid bone defect, especially when the shoulder is exposed to high-energy trauma in the early phase after surgery.

National dose reference levels in computed tomography-guided interventional procedures-a proposal.

OBJECTIVES: To establish national reference levels (RLs) in interventional procedures under CT guidance as required by the 2013/59/Euratom European Directive. METHODS: Seventeen categories of interventional procedures in thoracic, abdominopelvic, and osteoarticular specialties (percutaneous infiltration, vertebroplasty, biopsy, drainage, tumor destruction) were analyzed. Total dose length product (DLP), number of helical acquisitions (NH), and total DLP for helical, sequential, or fluoroscopic acquisitions were recorded for 10 to 20 patients per procedure at each center. RLs were calculated as the 3rd quartiles of the distributions and target values for optimization process (TVOs) as the median. RLs and TVOs were compared with previously published studies. RESULTS: Results on 5001 procedures from 49 centers confirmed the great variability in patient dose for the same category of procedures. RLs were proposed for the DLPs and NHs in the seventeen categories. RLs in terms of DLP and NH were 375 mGy.cm and 2 NH for spinal or peri-spinal infiltration, 1630 mGy.cm and 3 NH for vertebroplasty, 845 mGy.cm and 4 NH for biopsy, 1950 mGy.cm and 8 NH for destruction of tumors, and 1090 mGy.cm and 5 NH for drainage. DLP and NH increased with the complexity of procedures. CONCLUSIONS: This study was the first nationwide multicentric survey to propose RLs for interventional procedures under CT guidance. Heterogeneity of practice in centers were found with different levels of patient doses for the same procedure. The proposed RLs will allow imaging departments to benchmark their practice with others and optimize their protocols. KEY POINTS: • National reference levels are proposed for 17 categories of interventional procedures under CT guidance. • Reference levels are useful for benchmarking practices and optimizing protocols. • Reference levels are proposed for dose length product and the number of helical acquisitions.

Correction to: National dose reference levels in computed tomography-guided interventional procedures-a proposal.

The original version of this article, published on 02 May 2020, unfortunately contained a mistake.

Sensory innervation of the human shoulder joint: the three bridges to break.

BACKGROUND: Painful shoulders create a substantial socioeconomic burden and significant diagnostic challenge for shoulder surgeons. Consensus with respect to the anatomic location of sensory nerve branches is lacking. The aim of this literature review was to establish consensus with respect to the anatomic features of the articular branches (ABs) (1) innervating the shoulder joint and (2) the distribution of sensory receptors about its capsule and bursae. MATERIALS AND METHODS: Four electronic databases were queried, between January 1945 and June 2019. Thirty original articles providing a detailed description of the distribution of sensory receptors about the shoulder joint capsule (13) and its ABs (22) were reviewed. RESULTS: The suprascapular, lateral pectoral, axillary, and lower subscapular nerves were found to provide ABs to the shoulder joint. The highest density of nociceptors was found in the subacromial bursa. The highest density of mechanoreceptors was identified within the insertion of the glenohumeral ligaments. The most frequently identified innervation pattern comprised 3 nerve bridges (consisting of ABs from suprascapular, axillary, and lateral pectoral nerves) connecting the trigger and the identified pain generator areas rich in nociceptors. CONCLUSION: Current literature supports the presence of a common sensory innervation pattern for the human shoulder joint. Anatomic studies have demonstrated that the most common parent nerves supplying ABs to the shoulder joint are the suprascapular, lateral pectoral, and axillary nerves. Further studies are needed to assess both the safety and efficacy of selective denervation of the painful shoulders, while limiting the loss of proprioceptive function.

Case 264: A Case of Osseous Sarcoidosis.

History A 28-year-old woman presented to the emergency department with painful swelling of the third finger on her right hand, which developed quickly. She had no relevant medical or surgical history. Her pain was worse at night, with stiffness decreasing during the morning. Clinical examination revealed generalized swelling of the third finger, cyanotic skin, and fingernail splitting on the second finger of the left hand ( Fig 1 ). Laboratory test results were normal, with no evidence of inflammatory disease. Radiographs of both hands were obtained. CT scanning and MRI were also performed. Figure 1: Photograph of both of the patient's hands shows generalized swelling of the third digit of the right hand, corresponding to dactylitis (arrow). Also note the nail striations in the second digit of the left hand (∗).

Diffusion-weighted magnetic resonance imaging is useful for assessing inflammatory myopathies.

INTRODUCTION: Short tau inversion recovery (STIR) sequences in whole-body MRI are usually used for detecting muscle edema (ME) in inflammatory myopathies. We evaluated b-value 800 diffusion-weighted imaging (b800 DWI). METHODS: Two radiologists independently and a consensus reader retrospectively reexamined 60 patients with inflammatory myopathies and 15 controls. For each participant, 78 muscles were analyzed with 3 sets of imaging acquisitions: T1-weighted (T1) turbo spin echo and STIR; T1 and DWI; and T1, STIR and DWI. Mean edema per patient was compared between sequences. Agreement was evaluated. RESULTS: Diffusion-weighted imaging detected more ME compared with STIR (P < 0.001). Agreement between readers was better with both sequences (k = 0.94) than with b800 DWI (k = 0.89) or STIR (k = 0.84) alone. DISCUSSION: Diffusion-weighted imaging is a valuable add-on for the study of inflammatory myopathies. Muscle Nerve 59:555-555, 2019.

Whole-body MRI and pathological findings in adult patients with myopathies.

Magnetic resonance imaging (MRI) is considered the most sensitive and specific imaging technique for the detection of muscle diseases related to myopathies. Since 2008, the use of whole-body MRI (WBMRI) to evaluate myopathies has improved due to technical advances such as rolling table platform and parallel imaging, which enable rapid assessment of the entire musculoskeletal system with high-quality images. WBMRI protocols should include T1-weighted and short-tau inversion recovery (STIR), which provide the basic pulse sequences for studying myopathies, in order to detect fatty infiltration/muscle atrophy and muscle edema, respectively. High signal intensity in T1-weighted images shows chronic disease with fatty infiltration, whereas high signal intensity in STIR indicates an acute stage with muscle edema. Additional sequences such as diffusion-weighted imaging (DWI) can be readily incorporated into routine WBMRI study protocols. Contrast-enhanced sequences have not been done. This article reviews WBMRI as an imaging method to evaluate different myopathies (idiopathic inflammatory, dystrophic, non-dystrophic, metabolic, and channelopathies). WBMRI provides a comprehensive estimate of the total burden with a single study, seeking specific distribution patterns, including clinically silent involvement of muscle areas. Furthermore, WBMRI may help to select the "target muscle area" for biopsy during patient follow-up. It may be also be used to detect related and non-related pathological conditions, such as tumors.

Case 264.

History A 28-year-old woman presented to the emergency department with painful swelling of the third finger on her right hand, which developed quickly. She had no relevant medical or surgical history. Her pain was worse at night, with stiffness decreasing during the morning. Clinical examination revealed generalized swelling of the third finger, cyanotic skin, and fingernail splitting on the second finger of the left hand ( Fig 1 ). Laboratory test results were normal, with no evidence of inflammatory disease. Radiographs of both hands were obtained ( Fig 2 ). CT scanning ( Fig 3 ) and MRI ( Fig 4 ) were also performed. [Figure: see text] [Figure: see text] [Figure: see text] [Figure: see text] [Figure: see text] [Figure: see text] [Figure: see text] [Figure: see text].

Ultrasonographic Evaluation of Anterolateral Ligament Injuries: Correlation With Magnetic Resonance Imaging and Pivot-Shift Testing.

PURPOSE: (1) To compare the diagnostic ability of ultrasonography (US) and magnetic resonance imaging (MRI) to detect anterolateral ligament (ALL) injuries in anterior cruciate ligament (ACL)-deficient patients, and (2) to evaluate the correlation between ALL injury status (as determined by US and MRI) and the knee's rotational stability. METHODS: Thirty patients with an isolated ACL injury were included prospectively over a 3-month period. The condition of the ALL was evaluated by 2 experienced radiologists using both US and MRI. Rotational stability was evaluated by 2 surgeons with the pivot-shift test with patients under general anesthesia. It was classified as either negative (grades 0 and I) or positive (grades II and III). The radiologists were blinded to the knee's rotational stability, and the surgeons were blinded to the ALL's status based on the US images. The correlation between the ALL's injury status (US and MRI) and the pivot shift was determined with the Pearson χ2 test. To evaluate the reproducibility of the results, the agreement between observers was determined with the Cohen κ coefficient. RESULTS: On US, the ALL was identified and visible over its entire length in 100% of patients (30 of 30, κ = 1). The ALL was injured in 63% of patients (19 of 30, κ = 0.93). On MRI, the ALL was identified in 96% of patients (29 of 30, κ = 0.91). The ALL appeared injured in 53% of cases (16 of 30, κ = 0.93). An ALL that appeared injured on US was more often associated with a positive pivot shift than was an uninjured ALL (75% vs 39%, χ2 = 13.7, P < .05). The interobserver agreement was high for both US (κ = 0.91-1) and MRI (κ = 0.76-1). CONCLUSIONS: US is a reproducible examination for the diagnosis of ALL injury. An ALL injury is most often associated with a high pivot-shift grade. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Historical perspective on the "discovery" of the anterolateral ligament of the knee.

There is a lively debate about the existence, origins and discoverer of the anterolateral ligament of the knee. The complex anatomy of the lateral aspect of the knee has made it difficult to differentiate between various structures such as the iliotibial band, capsulo-osseous layer, Kaplan's fibres and the anterolateral capsule. The "discovery" of a new anterolateral structure in 2013 was the culmination of many historical studies. In 1879, Paul Ferdinand Segond described a tibial plateau fracture in which he noted a pearly band reinforcing the joint capsule. Other anatomists had their suspicions about this ligament; it was described by Vallois in 1914 in his thesis and extensively studied by Jost in 1921. References to it can be found in comparative anatomy studies. This historical review serves as a reminder that understanding and treating knee sprains is not something new. LEVEL OF EVIDENCE: V.

No difference in outcome for open versus arthroscopic rotator cuff repair: a prospective comparative trial.

PURPOSE: Arthroscopic techniques tend to become the gold standard in rotator cuff repair. However, little data are reported in the literature regarding the improvement of postoperative outcomes and re-tear rate relative to conventional open surgery. The aim of this study was to compare clinical outcomes and cuff integrity after arthroscopic versus open cuff repair. METHODS: We prospectively assessed clinical outcomes and cuff integrity after an arthroscopic or open rotator cuff repair with a minimum follow-up of 12 months. Clinical evaluation was based on Constant score, Simple Shoulder Value (SSV) and American Shoulder and Elbow Score (ASES). Rotator cuff healing was explored with ultrasound. RESULTS: 44 patients in arthroscopic group A (mean age 56-year-old) and 43 in open group O (mean age 61-year-old) fulfilled the inclusion criteria. Tendons were repaired with a single row technique associated with biceps tenodesis and subacromial decompression. All objective clinical scores significantly improved postoperatively in both groups. No statistical difference was identified between group A and O regarding, respectively, Constant score (72 vs 75 points; p = 0.3), ASES score (88 vs 91 points; p = 0.3), and SSV (81 vs 85%). The overall rate of re-tear (Sugaya type IV or V) reached 7 and 9%, respectively, in group A and O (p = 0.8). CONCLUSION: This study did not prove any difference of arthroscopic over open surgery in case of rotator cuff repair regarding clinical outcome and cuff integrity at 1-year follow-up. LEVEL II: Prospective comparative study.

US-guided Percutaneous Release of the Trigger Finger by Using a 21-gauge Needle: A Prospective Study of 60 Cases.

Purpose To evaluate the efficacy of ultrasonographically (US)-guided percutaneous treatment of the trigger finger by releasing the A1 pulley with a 21-gauge needle. Materials and Methods This two-part study was approved by the ethics committee, and written consent was obtained from all patients. The first part consisted of 10 procedures on cadaver digits followed by dissection to analyze the effectiveness of the A1 pulley release and detect any collateral damage to the A2 pulley, interdigital nerves, or underlying flexor tendons. The second part was performed during an 18-month period starting in March 2013. It was a prospective clinical study of 60 procedures performed in 48 patients. Outcomes were evaluated through a clinical examination at day 0 and during a 6-month follow-up visit, where the trigger digit was evaluated clinically and the Quick Disabilities of the Arm, Shoulder and Hand outcome measure, or QuickDASH, and patient satisfaction questionnaires were administered. Results No complications were found during the cadaver study. However, the release was considered "partial" in all fingers. In the clinical study, the trigger finger was completely resolved in 81.7% (49 of 60) of cases immediately after the procedure. Moderate trigger finger persisted in 10 cases, and one thumb pulley could not be released. A US-guided corticosteroid injection was subsequently performed in these 11 cases. At 6-month follow-up, only two cases still had moderate trigger finger and there were no late complications. The mean QuickDASH questionnaire score was 4; all patients said they were satisfied. Conclusion US-guided treatment of the trigger finger by using a 21-gauge needle is feasible in current practice, with minimal complications. (©) RSNA, 2016 Online supplemental material is available for this article.

Ultrasonographic Identification of the Anterolateral Ligament of the Knee.

PURPOSE: To determine ultrasonography's sensitivity for identifying the anterolateral ligament (ALL). METHODS: A descriptive study of 18 cadaveric knees was performed. Ultrasonography was used to locate any anterolateral structures at the knee that could correspond to the ALL. The structure's length and relation with other notable anatomic landmarks (fibular head, Gerdy tubercle, joint line, lateral femoral epicondyle, popliteus tendon insertion) were quantified. The ultrasonography measurements were validated by dissecting each knee. The sensitivity of ultrasonography for detecting the ALL and the agreement between the ultrasonographic and cadaveric measurements (Cohen κ) were determined by statistical analysis. RESULTS: The ALL was found in all 18 cadaveric knees and corresponded anatomically to the ultrasonographic descriptions. Ultrasonography had 100% sensitivity for detecting the presence of the ALL. The ALL's insertion on the lateral femoral condyle was, on average, 12.08 mm (SD, 4 mm; range, 7 to 15 mm) proximal and posterior to the lateral femoral epicondyle and 20.5 mm (SD, 3 mm; range, 16 to 24 mm) proximal to the middle of the popliteus tendon insertion. The ALL inserted onto the tibia, midway between the Gerdy tubercle and the fibular head; the distance between the midpoint of the tibial insertion and middle of the Gerdy tubercle was 19.05 mm (SD, 2.1 mm; range, 15 to 25 mm), and the distance was 19.13 mm (SD, 2.3 mm; range, 14 to 23 mm) to the tip of the fibular head. The agreement between the ultrasonographic and cadaveric findings was excellent (Cohen κ coefficient between 0.88 and 0.94). CONCLUSIONS: Ultrasound imaging is a suitable tool for identifying the ALL of the knee, and it allowed for a detailed analysis of the entire ALL in all 18 knees. However, its ability to evaluate any injuries to the ALL must still be shown. CLINICAL RELEVANCE: Ultrasonography can be used to confirm the integrity of the ALL.

Is the Latarjet procedure risky? Analysis of complications and learning curve.

PURPOSE: The purpose of this study was to analyse the learning curve and complication rate of the open Latarjet procedure. METHODS: The first 68 Latarjet procedures performed by a single surgeon for chronic anterior shoulder instability were reviewed retrospectively. The standard open surgical technique was followed faithfully during each procedure. Post-operative complications were taken from patient medical records. Post-operative evaluation consisted of clinical and radiological assessments. RESULTS: The rate of early (<3 months) clinical complications was 7.4 % (5.9 % haematoma, 1.5 % neurological deficit), and the delayed complication rate was 7.3 %. Early complication rate, duration of surgery (mean 65 min; 35-135) and hospital stay (mean 3 days; 1-4) were significantly reduced as experience increased (respectively; P = 0.03, ρ = - 0.3; P = 0.009, ρ = - 0.3; P < 0.0001, ρ = - 0.6). On the radiographs, the bone block was healed and in perfect position in 87 % of cases, with no effect of surgical experience (P = 0.3, ρ = 0.1). The rate of complications on radiographs was 17 %: 11 % partial lysis, 2 % complete lysis and 4 % non-union. No recurrence of instability was found after an average follow-up of 21 months. CONCLUSION: Despite a high rate of post-operative complications, the morbidity of Latarjet procedure remains low. A surgeon's experience significantly affects the surgery duration and the occurrence of early complications. The main radiological complication is partial lysis of the bone block. After a short learning curve, the clinical outcomes of the Latarjet procedure appear to be satisfactory and reproducible. LEVEL OF EVIDENCE: IV.

Does microvascularization of the footprint play a role in rotator cuff healing of the shoulder?

BACKGROUND: The aim of the study was to evaluate the relationship between bone microvascularization of the footprint and tendon integrity after rotator cuff repair of the shoulder. METHODS: Forty-eight patients (mean age, 59 years; ±7.9) with a chronic rotator cuff tear underwent a tendon repair with a single-row technique and were studied prospectively. A core obtained from the footprint during the procedure allowed determination of the bone's microvascularization with an immunohistochemistry technique using anti-CD34 antibodies. Clinical evaluation was performed at a minimum of 12-month follow-up, and rotator cuff integrity was assessed with ultrasound according to Sugaya's classification. RESULTS: At a mean follow-up of 13 months, the Constant score improved from 40 to 75 points; American Shoulder and Elbow Surgeons score, from 59 to 89 points; and subjective shoulder value, from 38% to 83% (P < .001). Ultrasound identified 18 patients with Sugaya type I healing, 27 patients with type II, and 3 patients with type IV. No patients showed Sugaya type III or V repairs. The rate of microvascularization of the footprint was 15.6%, 13.9%, and 4.2% for type I, II, and IV tendon integrity, respectively (I vs. II, P = .22; II vs. IV, P = .02; I vs. IV, P = .0022). Patients with a history of corticosteroid injection had a lower rate of microvascularization than the others (10.3% vs. 16.2%; P = .03). CONCLUSIONS: Even if overall satisfactory clinical outcomes are achieved after a rotator cuff repair, bone microvascularization of the footprint plays a role in rotator cuff healing. A lower rate of microvessels decreases the tendon integrity and healing potential after repair.

3-T MRI with diffusion tensor imaging and tractography of the median nerve.

OBJECTIVE: To apply diffusion tensor imaging (DTI) and tractography to the median nerve by use of a 3-T MRI device in order to demonstrate potential differences in diffusion parameters between healthy subjects and patients with carpal tunnel syndrome (CTS). METHODS: The median nerve of 15 patients and 20 healthy volunteers was examined in two sequences: DTI and a high-resolution T1-weighted sequence. Mean fractional anisotropy (FA) and mean apparent diffusion coefficient (ADC) were measured based on tractography findings. Mean FA was significantly lower in CTS patients (P = 0.01) whereas no significant difference was found in mean ADC. Focal measurements of FA and ADC were also obtained at three locations along the course of the median nerve. RESULTS: We observed a highly significant difference (P < 0.0001) between FA measured at the proximal carpus and FA measured at the distal carpus in healthy subjects and CTS patients. Focal FA values along the median nerve showed an opposite trend in the two groups: in healthy subjects FA tended to increase (P < 0.05) whereas in subjects with CTS it tended to decrease (P = 0.0001). We defined a threshold value of -0.058 (FA3-FA1) that was sensitive and specific for nerve compression. CONCLUSION: DTI and tractography can detect chronic nerve compression. KEY POINTS: • Diffusion tensor magnetic resonance imaging offers new information about carpal tunnel syndrome. • Diffusion tensor MRI of the median nerve provides some functional data. • Mean fractional anisotropy (FA) was lower in patients with CTS than volunteers. • There was no significant difference in ADC values between patients and volunteers. • Fractional anisotropy seems a sensitive and specific predictor of chronic nerve compression.

Which preoperative factors influence the patient's short-term subjective assessment after rotator cuff repair?

INTRODUCTION: To highlight the preoperative risk factors that influence postoperative patient satisfaction following Rotator Cuff Repair (RCR) and to determine whether this satisfaction was correlated with tendon healing. HYPOTHESIS: Preoperative factors influence patient satisfaction, assessed by SSV (Subjective Shoulder Value) postoperatively, with a correlation with tendon healing. METHODS: With a mean age of 60.6 years (40-72), 102 patients with arthroscopic RCR were included retrospectively. The preoperative SSV score was less than or equal to 50%. There was clinical and radiological follow-up with an ultrasound evaluation of tendon healing 6 months postoperatively. We divided the patients into 2 groups using a postoperative SSV of 85% as the cut-off; 55 patients in the first group (SSV>85%); and 47 patients in the second group (SSV<85%). RESULTS: In multivariate analysis, Preoperative risk factors for poor postoperative SSV after RCR were: tobacco use [-8.41 (-13.64; -3.17) p=0.002], fatty infiltration [-3.65 (-6.24 -1.06) p=0.006] and workers compensation [-19.15 (-24.04; -14.27) p<0.001]. When patients were not in workers compensation, the lower their SSV score before surgery, the higher their postoperative SSV score. For patients in workers compensation, the higher the SSV preoperatively, the less elevated was SSV postoperatively. The Sugaya ultrasound classification did not influence the SSV score (p=0.15) CONCLUSIONS: Smoking, fatty infiltration and patients in workers compensation are factors of poorer subjective results evaluated by the SSV score. Tendon healing did not influence the SSV score and patient satisfaction. LEVEL OF EVIDENCE: IV, cohort study.