This retrospective CT study of 190 shoulders in patients with primary glenohumeral OA asks whether rotator cuff fatty infiltration tracks with specific patterns of glenoid bone loss. Glenoids were graded by the modified Walch classification and cuff quality by Goutallier score. The goal was to link soft-tissue degeneration to osseous deformity before TSA.
When you read a preoperative CT for a type-B glenoid, do not stop at the bone. This study shows the posterior cuff quality travels with the deformity. B3 glenoids, defined by loss of the paleoglenoid (<25% of glenoid diameter) with high retroversion and joint-line medialization, carry high-grade posterior cuff fatty infiltration in over half of cases.
That matters because preoperative infraspinatus fatty infiltration independently predicts posterior subluxation, glenoid loosening, and worse outcomes after anatomic TSA. The practical mental model: retroversion and medialization selectively degrade the posterior cuff (infraspinatus and teres minor), while the subscapularis is spared.
Because this is cross-sectional, it cannot tell you whether the weak cuff caused the wear or the wear caused the weakness. Use it to raise your suspicion, not to assign causation, and to weigh whether an anatomic TSA or a reverse is the safer choice in a poor-cuff B3.
This retrospective CT study of 190 shoulders in patients with primary glenohumeral OA asks whether rotator cuff fatty infiltration tracks with specific patterns of glenoid bone loss. Glenoids were graded by the modified Walch classification and cuff quality by Goutallier score. The goal was to link soft-tissue degeneration to osseous deformity before TSA.
When you read a preoperative CT for a type-B glenoid, do not stop at the bone. This study shows the posterior cuff quality travels with the deformity. B3 glenoids, defined by loss of the paleoglenoid (<25% of glenoid diameter) with high retroversion and joint-line medialization, carry high-grade posterior cuff fatty infiltration in over half of cases.
That matters because preoperative infraspinatus fatty infiltration independently predicts posterior subluxation, glenoid loosening, and worse outcomes after anatomic TSA. The practical mental model: retroversion and medialization selectively degrade the posterior cuff (infraspinatus and teres minor), while the subscapularis is spared.
Because this is cross-sectional, it cannot tell you whether the weak cuff caused the wear or the wear caused the weakness. Use it to raise your suspicion, not to assign causation, and to weigh whether an anatomic TSA or a reverse is the safer choice in a poor-cuff B3.