Goutallier, J Shoulder Elbow Surg 2003 - Influence of Cuff Muscle Fatty Degeneration on Anatomic and Functional Outcomes after Simple Suture of Full-Thickness Tears
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Influence of Cuff Muscle Fatty Degeneration on Anatomic and Functional Outcomes after Simple Suture of Full-Thickness Tears
Goutallier, Van Driessche, et al.·J Shoulder Elbow Surg·2003·966 citations·Retrospective cohort
Goutallier and colleagues tested whether the severity of presurgical cuff muscle fatty degeneration influenced retear and function after simple tendon‑to‑bone repair of full‑thickness rotator cuff tears.
Cohort of 220 shoulders after simple tendon‑to‑bone repair, with cuff integrity imaged at a mean 37 months.
Methods
Design
Retrospective multicenter cohort
Data source
Multicenter, France
Patients
220 shoulders with full‑thickness rotator cuff tears
Treated with simple suture of tendon to bone
Exposure
Presurgical fatty degeneration of each cuff muscle (Goutallier 5‑stage grading)
Global fatty degeneration index (GFDI), the mean grade of the 3 muscles
Follow-up
12–56 months (mean 37)
Outcomes
Cuff integrity on MRI (116) or CT arthrography (104)
Constant score
Key Findings
Tendons retore more often when their muscle showed fatty degeneration above grade 1, which appeared to be the cutoff between integrity and retear for each cuff muscle.
Retear was found in 36% of shoulders (79 of 220) and was more common in posterosuperior tears.
For supraspinatus, supraspinatus‑infraspinatus and three‑tendon tears a GFDI below 0.5 kept the retear rate under 25%, while the threshold was 0.75 when the subscapularis was involved.
Supraspinatus retear was associated with worse fatty degeneration of the infraspinatus (p < 0.0001) and of the subscapularis (p = 0.006).
Mean Constant score rose from 46 before surgery to 77.75 with an intact repair vs 70.44 with a retear (p < 0.0001).
Higher presurgical GFDI was associated with a worse Constant score, including in cuffs that stayed intact (p < 0.0001).
Board pearl
The GFDI is the mean presurgical fatty degeneration grade of the supraspinatus, infraspinatus and subscapularis, so all three muscles count toward one shoulder's score.
Authors' conclusion
Fatty degeneration is an important prognostic factor in rotator cuff surgery.
Goutallier and colleagues tested whether the severity of presurgical cuff muscle fatty degeneration influenced retear and function after simple tendon‑to‑bone repair of full‑thickness rotator cuff tears.
Cohort of 220 shoulders after simple tendon‑to‑bone repair, with cuff integrity imaged at a mean 37 months.
Methods
Design
Retrospective multicenter cohort
Data source
Multicenter, France
Patients
220 shoulders with full‑thickness rotator cuff tears
Treated with simple suture of tendon to bone
Exposure
Presurgical fatty degeneration of each cuff muscle (Goutallier 5‑stage grading)
Global fatty degeneration index (GFDI), the mean grade of the 3 muscles
Follow-up
12–56 months (mean 37)
Outcomes
Cuff integrity on MRI (116) or CT arthrography (104)
Constant score
Key Findings
Tendons retore more often when their muscle showed fatty degeneration above grade 1, which appeared to be the cutoff between integrity and retear for each cuff muscle.
Retear was found in 36% of shoulders (79 of 220) and was more common in posterosuperior tears.
For supraspinatus, supraspinatus‑infraspinatus and three‑tendon tears a GFDI below 0.5 kept the retear rate under 25%, while the threshold was 0.75 when the subscapularis was involved.
Supraspinatus retear was associated with worse fatty degeneration of the infraspinatus (p < 0.0001) and of the subscapularis (p = 0.006).
Mean Constant score rose from 46 before surgery to 77.75 with an intact repair vs 70.44 with a retear (p < 0.0001).
Higher presurgical GFDI was associated with a worse Constant score, including in cuffs that stayed intact (p < 0.0001).
Board pearl
The GFDI is the mean presurgical fatty degeneration grade of the supraspinatus, infraspinatus and subscapularis, so all three muscles count toward one shoulder's score.
Authors' conclusion
Fatty degeneration is an important prognostic factor in rotator cuff surgery.