Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears
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In some patients nonoperative treatment of a rotator cuff tear is sufficient, while in others it is only the first stage of treatment prior to surgery. Fatty infiltration progresses throughout the nonoperative treatment although it is not known at what point fatty infiltration contributes to poor functional outcomes, absence of healing, or increased rerupture rates.
We therefore identified factors related to the appearance of supraspinatus muscle fatty infiltration, determined the speed of appearance and progression of this phenomenon, and correlated fatty infiltration with muscular atrophy.
We retrospectively reviewed 1688 patients with rotator cuff tears and recorded the following: number of tendons torn, etiology of the tear, time between onset of shoulder symptoms and diagnosis of rotator cuff tear. Fatty infiltration of the supraspinatus was graded using either CT or MRI classification. Muscular atrophy was measured indirectly using the tangent sign.
Moderate supraspinatus fatty infiltration appeared an average of 3 years after onset of symptoms and severe fatty infiltration at an average of 5 years after the onset of symptoms. A positive tangent sign appeared at an average of 4.5 years after the onset of symptoms.
Our results suggest that rotator cuff repair should be performed before the appearance of fatty infiltration (Stage 2) and atrophy (positive tangent sign)—especially when the tear involves multiple tendons.
Level of Evidence
Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Bernageau J, Goutallier D, Postel JM. Density study of the muscles of the rotator cuff [in French]. In: Laredo JD, Bard H eds. Monographies du GETROA. Montpellier, France: Sauramps Medical; 1993:277–281.
- Bigliani LU, Cordasco FA, McIlveen SJ, Musso ES. Operative treatment of failed repairs of the rotator cuff. J Bone Joint Surg Am. 1992;74:1505–1515.
- Bjoerkenheim J. Structure and function of the rabbit’s supraspinatus muscle after resection of its tendon. Acta Orthop Scand. 1989;60:461–463. CrossRef
- De Franco MJ, Bershadsky B, Ciccone J, Yum JK, Iannotti JP. Functional outcome of arthroscopic rotator cuff repairs: a correlation of anatomic and clinical results. J Shoulder Elbow Surg. 2007;16:759–765. CrossRef
- Fuchs B, Gilbart M, Hodler J, Gerber Ch. Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff. J Bone Joint Surg Am. 2006;88:309–316. CrossRef
- Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8:599–605. CrossRef
- Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res. 1994;304:43–53.
- Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82:505–515.
- Gerber Ch, Meyer D, Frey E, von Rechenberg B, Hoppeler H, Frigg R, Jost B, Zumstein M. Reversion of structural muscle changes caused by chronic rotator cuff tears using continous musculotendinous traction: An experimental study in sheep. J Shoulder Elbow Surg. 2009;18:163–171. CrossRef
- Gladstone JN, Bishop JY, Lo IKY, Flatow EL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med. 2007;35:719–728. CrossRef
- Goutallier D, Bernageau J, Patte D. Assessment of the trophicity of the muscles of the ruptured rotator cuff by CT scan. In: Post M, Morrey BF, Hawkins RJ, eds. Surgery of the Shoulder. St. Louis, MO: Mosby; 1990:11–13.
- Goutallier D, Le Guilloux P, Postel JM, Gleyze P. Fatty muscular degeneration [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1999;85(2):132–136.
- Goutallier D, Postel JM, Lavau L, Bernageau J. Influence of muscular degeneration of the supra and infraspinatus on the prognosis of surgical repair of the rotator cuff [in French]. Acta Orthop Belg. 1998;64:41–45.
- Goutallier D, Postel JM, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.
- Harryman DT II, Mack LA, Wang KY, Jackins SE, Richardson ML, Masten FA. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73:982–989.
- Jost B, Zumstein M, Pfirrmann Ch, Gerber Ch. Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2006;88:472–479.
- Lesage P, Maynou C, Elhage R, Boutry N, Herent S, Mestdagh H. Reproducibility of the tomographic evaluation of muscular fatty degeneration [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2002;88:359–364.
- Liem D, Lichtenberg S, Magosch P, Habermeyer P. Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am. 2007;89:1770–1776. CrossRef
- Mellado JM, Calmet J, Olona M, Esteve C, Camins A, Perez Del Palomar L, Gine J, Sauri A. Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. Am J Roentgenol. 2005;184:1456–1463.
- Nakagaki K, Ozaki J, Tomita Y, Tamai S. Alterations in the supraspinatus muscle belly with rotator cuff tearing: Evaluation with magnetic resonance imaging. J Shoulder Elbow Surg. 1994;3:88–93. CrossRef
- Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;254:81–86.
- Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F. Atrophy of the supraspinatus belly: assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand. 1996;67:264–268. CrossRef
- Warner JJP, Higgins L, Parson IM IV, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg. 2001;10:37–46. CrossRef
- Williams MD, Lädermann A, Melis B, Barthelemy R, Walch G. Fatty infiltration of the supraspinatus: a reliability study. J Shoulder Elbow Surg. 2009;18:581–587. CrossRef
- Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic ansd symptomatic shoulders. J Bone Joint Surg Am. 2006;88:1699–1704. CrossRef
- Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol. 1998;33:163–170. CrossRef
- Natural History of Fatty Infiltration and Atrophy of the Supraspinatus Muscle in Rotator Cuff Tears
Clinical Orthopaedics and Related Research®
Volume 468, Issue 6 , pp 1498-1505
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- 1. Centre Orthopédique Santy, Lyon, France
- 2. Harvard Shoulder Service, Massachusetts General Hospital, Yawkey Center for Outpatient Care, Boston, MA, USA
- 3. Shoulder and Elbow Service, Great Lakes Orthopaedic Center, 4045 West Royal Drive, Traverse City, MI, 49684, USA