Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears

doi:10.1016/S1058-2746(03)00211-8

Journal of Shoulder and Elbow Surgery

Volume 12, Issue 6, November–December 2003, Pages 550-554

https://doi.org/10.1016/S1058-2746(03)00211-8 Get rights and content

Abstract

Two hundred twenty shoulders with a rotator cuff tear repaired by simple tendon-to-bone suture were analyzed to determine whether the severity of presurgical fatty degeneration had an influence on their anatomic and functional outcome. Fatty degeneration was evaluated for each muscle with the 5-stage grading system developed by Goutallier et al. A global fatty degeneration index (GFDI), the mean value of the 3 muscles, was calculated for each shoulder. Cuff integrity was evaluated by magnetic resonance imaging (116 cases) or computed arthrotomography scan (104 cases) at a mean 37 months' follow-up, and functional outcomes were evaluated with the Constant score. A recurrent tear was found in 79 cases (36%) and was more frequently encountered in posterosuperior tears. The likelihood of a recurrent tear was greater for tendons whose muscle showed fatty degeneration greater than grade 1. Fatty degeneration of the infraspinatus or subscapularis muscles had an influence on supraspinatus tendon outcome. A GFDI lower than 0.5 was necessary to yield less than 25% retears. The mean global Constant score was 75 at revision, significantly lower when a retear was present (70.5 versus 77.5). In the subgroup of watertight cuffs, it was lower when GFDI was higher. Fatty degeneration is an important prognostic factor in rotator cuff surgery.

Section snippets

Materials and methods

In this retrospective multicenter descriptive study, the results of 543 repairs of full-thickness rotator cuff tears were reviewed at the 1998 meeting of the French Society for Orthopedic and Trauma Surgery. Among the 543 shoulders studied, 220 met the following three criteria: tendon repair was achieved by simple tendon-to-bone suturing with no muscle or tendon plasty; fatty degeneration in the various cuff muscles was evaluated before surgery; and, at last follow-up, cuff integrity was

Results

Of the 220 cuffs, 141 (64%) were intact by CT or MRI and 79 (36%) showed a recurrent tear. The recurrent tears were located in the repaired tendons. The proportion of recurrences was 36% (70/194) for the supraspinatus, 39% (22/57) for the infraspinatus, and 26% (20/76) for the subscapularis. Proportions of recurrent tears based on the number of repaired tendons were as follows: 33% (34/103) for isolated supraspinatus tears, 56% (23/41) for combined supraspinatus and infraspinatus tears, 29%

Discussion

This study has the bias common to any retrospective multicenter analysis. There were some differences between the investigating surgeons with regard to the technique of repair of the cuff, which probably had an influence on the anatomic and functional outcome.

The assessment of fatty degeneration was done by one examiner in each center, which raises the question of its reproducibility. Recent studies have shown that the GFDI is a reproducible parameter, with good interobserver and intraobserver

Acknowledgements

We thank B. Augereau, Y. Bellumore, H. Coudane, O. Gagey, D. Gazielly, C. Gerber, J. F. Kempf, D. Molé, and G. Walch for actively contributing to this work.

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A scoping review with best evidence synthesis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE (OVID), EMBASE (OVID), Cochrane Library (Wiley), SCOPUS, Web of Science Core Collection, CINAHL Plus with Full Text (EBSCOhost), PubMed Central, and Science Direct were searched from 2000 to March 3, 2023. Level 1 studies, and systematic reviews and meta-analyses that included level 1 and 2 studies, were included.
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Original articleInfluence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears

Abstract

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Results of the surgical repair of the rotator cuff. Radio-clinical correlation

Rev Chir Orthop Reparatrice Appar Mot

Contribution à la biomécanique de l'articulation gléno-humérale

Rev Chir Orthop Reparatrice Appar Mot

A clinical method of functional assessment of the shoulder

Clin Orthop

Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 1Preoperative functional and anatomical evaluation of ruptures of the rotator cuff

Rev Chir Orthop Reparatrice Appar Mot

Assessment of the trophicity of the muscles of the ruptured rotator cuff by CT scan

Fatty muscle degeneration in cuff rupturespre and post operative evaluation by CT scan

Clin Orthop

Original article
Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears