A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes

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

  1. 1.

    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.

    Article  PubMed  Google Scholar 

  2. 2.

    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.

    CAS  PubMed  Google Scholar 

  3. 3.

    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.

    Article  PubMed  Google Scholar 

  4. 4.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    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.

    Article  PubMed  Google Scholar 

  6. 6.

    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.

    PubMed  Google Scholar 

  7. 7.

    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.

    Article  PubMed  Google Scholar 

  8. 8.

    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.

    Article  PubMed  Google Scholar 

  9. 9.

    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.

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    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.

    Article  PubMed  Google Scholar 

  11. 11.

    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.

    CAS  PubMed  Google Scholar 

  12. 12.

    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.

    Article  PubMed  Google Scholar 

  13. 13.

    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.

    Article  PubMed  Google Scholar 

  14. 14.

    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.

    Article  PubMed  Google Scholar 

  15. 15.

    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.

  16. 16.

    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.

    Article  PubMed  Google Scholar 

  17. 17.

    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.

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    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.

    Article  PubMed  Google Scholar 

  19. 19.

    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.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    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.

    Article  PubMed  Google Scholar 

  21. 21.

    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.

    PubMed  Google Scholar 

  22. 22.

    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.

    Article  PubMed  Google Scholar 

  23. 23.

    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.

    CAS  PubMed  Google Scholar 

  24. 24.

    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.

    Article  PubMed  Google Scholar 

  25. 25.

    Mall NA, Tanaka MJ, Choi LS, Paletta GA Jr. Factors affecting rotator cuff healing. J Bone Joint Surg Am. 2014; 96(9): 778-788.

    Article  PubMed  Google Scholar 

  26. 26.

    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.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    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.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    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.

    Article  PubMed  Google Scholar 

  29. 29.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    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.

    Article  PubMed  Google Scholar 

  31. 31.

    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.

    Article  PubMed  Google Scholar 

  32. 32.

    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.

    Article  PubMed  Google Scholar 

  33. 33.

    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.

    Article  PubMed  Google Scholar 

  34. 34.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    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.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    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.

    Article  PubMed  Google Scholar 

  38. 38.

    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.

    Article  PubMed  Google Scholar 

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Disclosures

Conflict of Interest

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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Correspondence to Nicholas Tsouris BS.

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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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Keywords

  • massive rotator cuff tears
  • rotator cuff tears
  • fatty infiltration
  • Goutallier score
  • functional outcomes
  • retear rates
  • preoperative evaluation