Clinical Orthopaedics and Related Research®

, Volume 470, Issue 10, pp 2776–2784

Does Open Repair of Anterosuperior Rotator Cuff Tear Prevent Muscular Atrophy and Fatty Infiltration?

  • Marion Di Schino
  • Bernard Augereau
  • Christophe Nich
Clinical Research



Repair of cuff tears involving rotator interval reportedly improves function. However, it is unclear whether successful repair prevents shoulder degenerative changes.


Therefore, we (1) documented the minimal 4-year function of patients who underwent open surgical repair for rotator interval tears; (2) evaluated repaired tendon healing with postoperative MRI; and (3) sought to determine the influence of tendon healing on muscular and glenohumeral joint changes.


We retrospectively analyzed 22 patients (23 shoulders) treated by open transosseous reinsertion of supraspinatus and subscapularis tendons. The mean age of the patients was 53 years (range, 37–64 years). The tear was traumatic in four cases. Repair healing and muscular changes were assessed using MRI. The minimum followup was 46 months (mean, 75 months; range, 46–103 months).


We observed an improvement in the absolute Constant-Murley score from 63 points preoperatively to 76 points postoperatively. With the last followup MRI, the supraspinatus tendon repair had failed in two of the 23 shoulders, whereas the subscapularis tendon repair had healed in all cases. Once healing of the repaired tendon occurred, supraspinatus muscle atrophy never worsened. However, on MRI fatty infiltration of the rotator cuff muscles increased despite successful tendon repair. Glenohumeral arthritis remained stable. Postoperative abduction and internal rotation strengths were better when the standardized supraspinatus muscle area was greater than 0.5 at the final evaluation.


Durable functional improvement and limited degenerative articular and muscular changes can be expected in most patients 4 to 10 years after open repair of anterosuperior cuff tears provided that healing of the cuff is obtained.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.


  1. 1.
    Bellumore Y, Mansat M, Assoun J. [Results of the surgical repair of the rotator cuff: radio-clinical correlation] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:582–594.PubMedGoogle Scholar
  2. 2.
    Bennett WF. Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy. 2003;19:21–33.PubMedGoogle Scholar
  3. 3.
    Burkhart SS. Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears: a suspension bridge model. Clin Orthop Relat Res. 1992;284:144–152.PubMedGoogle Scholar
  4. 4.
    Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears: a prospective long-term study. J Bone Joint Surg Am. 2001;83:71–77.PubMedGoogle Scholar
  5. 5.
    Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164.PubMedGoogle Scholar
  6. 6.
    Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon: clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997;25:13–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Ellman H, Hanker G, Bayer M. Repair of the rotator cuff: end-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:1136–1144.PubMedGoogle Scholar
  8. 8.
    Flury MP, John M, Goldhahn J, Schwyzer HK, Simmen BR. Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated? J Shoulder Elbow Surg. 2006;15:659–664.PubMedCrossRefGoogle Scholar
  9. 9.
    Fuchs B, Gilbart MK, Hodler J, Gerber C. 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.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    Gartsman GM. Massive, irreparable tears of the rotator cuff: results of operative debridement and subacromial decompression. J Bone Joint Surg Am. 1997;79:715–721.PubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am. 1996;78:1015–1023.PubMedGoogle Scholar
  14. 14.
    Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle: clinical features in 16 cases. J Bone Joint Surg Br. 1991;73:389–394.PubMedGoogle Scholar
  15. 15.
    Gladstone JN, Bishop JY, Lo IK, 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.PubMedCrossRefGoogle Scholar
  16. 16.
    Goutallier D, Postel JM, Bernageau J, 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.PubMedGoogle Scholar
  17. 17.
    Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg. 2004;13:5–12.PubMedCrossRefGoogle Scholar
  18. 18.
    Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd. Repairs of the rotator cuff: correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73:982–989.PubMedGoogle Scholar
  19. 19.
    Hawkins RJ, Misamore GW, Hobeika PE. Surgery for full-thickness rotator-cuff tears. J Bone Joint Surg Am. 1985;67:1349–1355.PubMedGoogle Scholar
  20. 20.
    Hsu JE, Reuther KE, Sarver JJ, Lee CS, Thomas SJ, Glaser DL, Soslowsky LJ. Restoration of anterior-posterior rotator cuff force balance improves shoulder function in a rat model of chronic massive tears. J Orthop Res. 2011;29:1028–1033.PubMedCrossRefGoogle Scholar
  21. 21.
    Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am. 2007;89:2378–2388.PubMedCrossRefGoogle Scholar
  22. 22.
    Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000;82:304–314.PubMedCrossRefGoogle Scholar
  23. 23.
    Kreuz PC, Remiger A, Erggelet C, Hinterwimmer S, Niemeyer P, Gächter A. Isolated and combined tears of the subscapularis tendon. Am J Sports Med. 2005;33:1831–1837.PubMedCrossRefGoogle Scholar
  24. 24.
    Lyons RP, Green A. Subscapularis tendon tears. J Am Acad Orthop Surg. 2005;13:353–363.PubMedGoogle Scholar
  25. 25.
    Mansat P, Frankle M, Cofield RH. Tears in the subscapularis tendon: descriptive analysis and results of surgical repair. Joint Bone Spine. 2003;70:342–347.PubMedCrossRefGoogle Scholar
  26. 26.
    Nakagaki K, Ozaki J, Tomita Y, Tamai S. Fatty degeneration in the supraspinatus muscle after rotator cuff tear. J Shoulder Elbow Surg. 1996;5:194–200.PubMedCrossRefGoogle Scholar
  27. 27.
    Namdari S, Henn F 3rd, Green A. Traumatic anterosuperior rotator cuff tears: the outcome of open surgical repair. J Bone Joint Surg Am. 2008;90:1906–1913.PubMedCrossRefGoogle Scholar
  28. 28.
    Nich C, Mütschler C, Vandenbussche E, Augereau B. Long-term clinical and MRI results of open repair of the supraspinatus tendon. Clin Orthop Relat Res. 2009;467:2613–2622.PubMedCrossRefGoogle Scholar
  29. 29.
    Nove-Josserand L, Gerber C, Walch G. Lesions of the anterosuperior rotator cuff. In: Warner JJP, Ianotti JP, Gerber C, eds. Complex and Revision Problems in Shoulder Surgery. Philadelphia, PA, USA: Lippincott-Raven; 1997:165–176.Google Scholar
  30. 30.
    Nove-Josserand L, Levigne C, Noël E, Walch G. [Isolated lesions of the subscapularis muscle: a propos of 21 cases] [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:595–601.PubMedGoogle Scholar
  31. 31.
    Romeo AA, Hang DW, Bach BR Jr, Shott S. Repair of full thickness rotator cuff tears: gender, age, and other factors affecting outcome. Clin Orthop Relat Res. 1999;367:243–255.PubMedCrossRefGoogle Scholar
  32. 32.
    Samilson RL, Prieto V. Dislocation arthropathy of the shoulder. J Bone Joint Surg Am. 1983;65:456–460.PubMedGoogle Scholar
  33. 33.
    Shen PH, Lien SB, Shen HC, Lee CH, Wu SS, Lin LC. Long-term functional outcomes after repair of rotator cuff tears correlated with atrophy of the supraspinatus muscles on magnetic resonance images. J Shoulder Elbow Surg. 2008;17(1 suppl):1S–7S.PubMedCrossRefGoogle Scholar
  34. 34.
    Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997;344:275–283.PubMedCrossRefGoogle Scholar
  35. 35.
    Uhthoff HK, Matsumoto F, Trudel G, Himori K. Early reattachment does not reverse atrophy and fat accumulation of the supraspinatus: an experimental study in rabbits. J Orthop Res. 2003;21:386–392.PubMedCrossRefGoogle Scholar
  36. 36.
    Warner JJ, Higgins L, Parsons IM 4th, Dowdy P. Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg. 2001;10:37–46.PubMedCrossRefGoogle Scholar
  37. 37.
    Wolf RS, Zheng N, Weichel D. Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis. Arthroscopy. 2005;21:182–185.PubMedCrossRefGoogle Scholar
  38. 38.
    Yamamoto N, Itoi E, Tuoheti Y, Seki N, Abe H, Minagawa H, Shimada Y, Okada K. Effect of rotator interval closure on glenohumeral stability and motion: a cadaveric study. J Shoulder Elbow Surg. 2006;15:750–758.PubMedCrossRefGoogle Scholar
  39. 39.
    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.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Marion Di Schino
    • 1
  • Bernard Augereau
    • 1
  • Christophe Nich
    • 1
  1. 1.Department of Traumatology and Orthopaedic SurgeryEuropean Hospital of ParisParis Cedex 15France

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