Abstract
Background
Fatty infiltration (FI) of the muscle as graded by the Goutallier classification (GC) is a well-known sequela following rotator cuff injury. The degree to which this predicts the success of rotator cuff repair is unknown.
Questions/Purposes
We conducted a systematic review to address the following questions: (1) Does the grade of FI of the rotator cuff muscles present preoperatively predict retear rates postoperatively? (2) Are amounts of preoperative FI predictive of functional outcomes following repair?
Methods
Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials online databases were searched for all literature published between January 1966 and March 2015. Keywords were chosen to achieve a broad search category. All articles were reviewed by three of the authors, and those meeting the study inclusion criteria were selected for data abstraction.
Results
The systematic literature review yielded 11 studies reporting on a total of 925 shoulders. Rotator cuffs with moderate or significant FI preoperatively (grades 2–4) had a significantly higher retear rate than those with no or minimal FI (grades 0–1) (59 vs. 25%, p = 0.045). Four studies reported postoperative Constant scores and preoperative GC scores. One study found that lower GC scores were associated with higher Constant scores postoperatively, one found no association, and the data was inconclusive in the other two.
Conclusions
While lower preoperative GC scores are associated with lower rates of rotator cuff retear following repair, there is insufficient data to make conclusions on the effects of FI on functional outcomes following repair.
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References
Burkhart SS, Barth JR, Richards DP, Zlatkin MB, Larsen M. Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy. 2007; 23(4): 347-354.
Calvert PT, Packer NP, Stoker DJ, Bayley JI, Kessel L. Arthrography of the shoulder after operative repair of the torn rotator cuff. J Bone Joint Surg Br. 1986; 68(1): 147-150.
Castagna A, Conti M, Markopoulos N, et al. Arthroscopic repair of rotator cuff tear with a modified Mason-Allen stitch: mid-term clinical and ultrasound outcomes. Knee Surg Sports Traumatol Arthrosc. 2008; 16(5): 497-503.
Cho NS, Rhee YG. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg. 2009; 1(2): 96-104.
Chung SW, Kim JY, Kim MH, Kim SH, Oh JH. Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med. 2013; 41(7): 1674-1683.
Coleman SH, Fealy S, Ehteshami JR, et al. Chronic rotator cuff injury and repair model in sheep. J Bone Joint Surg Am. 2003; 85-A(12): 2391-2402.
Demirors H, Circi E, Akgun RC, et al. Correlations of isokinetic measurements with tendon healing following open repair of rotator cuff tears. Int Orthop. 2010; 34(4): 531-536.
Deniz G, Kose O, Tugay A, Guler F, Turan A. Fatty degeneration and atrophy of the rotator cuff muscles after arthroscopic repair: does it improve, halt or deteriorate? Arch Orthop Trauma Surg. 2014; 134(7): 985-990.
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(6): 599-605.
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(2): 309-316.
Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000; 82(4): 505-515.
Gerber C, Schneeberger AG, Hoppeler H, Meyer DC. Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elbow Surg. 2007; 16(6): 691-696.
Gerber C, Meyer DC, Frey E, et al. Neer award 2007: Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep. J Shoulder Elbow Surg. 2009; 18(2): 163-171.
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(5): 719-728.
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.
Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003; 12(6): 550-554.
Goutallier D, Postel JM, Van Driessche S, Godefroy D, Radier C. Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: results in a prospective series with limited fatty muscular degeneration. J Shoulder Elbow Surg. 2006; 15(2): 164-172.
Goutallier D, Postel JM, Radier C, Bernageau J, Zilber S. Long-term functional and structural outcome in patients with intact repairs 1 year after open transosseous rotator cuff repair. J Shoulder Elbow Surg. 2009; 18(4): 521-528.
Goutallier D, Postel JM, Radier C, Bernageau J, Godefroy D, Zilber S. How repaired rotator cuff function influences constant scoring. Orthop Traumatol Surg Res. 2010; 96(5): 500-505.
Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C. Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy. 2009; 25(1): 4-12.
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(7): 982-989.
Ji X, Bi C, Wang F, Wang Q. Arthroscopic versus mini-open rotator cuff repair: an up-to-date meta-analysis of randomized controlled trials. Arthroscopy. 2015; 31(1): 118-124.
Jost B, Pfirrmann CW, Gerber C, Switzerland Z. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am. 2000; 82(3): 304-314.
Liem D, Lichtenberg S, Magosch P, Habermeyer P. Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am. 2007; 89(8): 1770-1776.
Mall NA, Tanaka MJ, Choi LS, Paletta GA Jr. Factors affecting rotator cuff healing. J Bone Joint Surg Am. 2014; 96(9): 778-788.
Mellado JM, Calmet J, Olona M, et al. Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol. 2005; 184(5): 1456-1463.
Mellado JM, Calmet J, Olona M, et al. MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture. Eur Radiol. 2006; 16(10): 2186-2196.
Milano G, Grasso A, Salvatore M, Saccomanno MF, Deriu L, Fabbriciani C. Arthroscopic rotator cuff repair with metal and biodegradable suture anchors: a prospective randomized study. Arthroscopy. 2010; 26(9 Suppl): S112-S119.
Nich C, Mutschler C, Vandenbussche E, Augereau B. Long-term clinical and MRI results of open repair of the supraspinatus tendon. Clin Orthop Relat Res. 2009; 467(10): 2613-2622.
Oh JH, Kim SH, Ji HM, Jo KH, Bin SW, Gong HS. Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy. 2009; 25(1): 30-39.
Park JY, Siti HT, Keum JS, Moon SG, Oh KS. Does an arthroscopic suture bridge technique maintain repair integrity?: a serial evaluation by ultrasonography. Clin Orthop Relat Res. 2010; 468(6): 1578-1587.
Schiefer M, Mendonca R, Magnanini MM, et al. Intraobserver and interobserver agreement of Goutallier classification applied to magnetic resonance images. J Shoulder Elbow Surg. 2015; 24(8): 1314-1321.
Sethi PM, Noonan BC, Cunningham J, Shreck E, Miller S. Repair results of 2-tendon rotator cuff tears utilizing the transosseous equivalent technique. J Shoulder Elbow Surg. 2010; 19(8): 1210-1217.
Shan L, Fu D, Chen K, Cai Z, Li G. All-arthroscopic versus mini-open repair of small to large sized rotator cuff tears: a meta-analysis of clinical outcomes. PLoS One. 2014; 9(4): e94421.
Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001; 10(3): 199-203.
Yi JW, Cho NS, Cho SH, Rhee YG. Arthroscopic suture bridge repair technique for full thickness rotator cuff tear. Clin Orthop Surg. 2010; 2(2): 105-111.
Yoo JC, Ahn JH, Koh KH, Lim KS. Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage. Arthroscopy. 2009; 25(10): 1093-1100.
Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008; 90(11): 2423-2431.
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M. Michael Khair, MD, Jason Lehman, MD and Nicholas Tsouris, BS have declared that they have no conflict of interest. Lawrence V. Gulotta, MD reports personal fees from Biomet, Inc., outside the work.
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Khair, M.M., Lehman, J., Tsouris, N. et al. A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes. HSS Jrnl 12, 170–176 (2016). https://doi.org/10.1007/s11420-015-9465-5
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DOI: https://doi.org/10.1007/s11420-015-9465-5