Retrospective multicenter study of 220 shoulders undergoing simple tendon-to-bone rotator cuff repair. The study asks whether preoperative fatty degeneration severity — graded with the Goutallier 5-stage system and summarized as a Global Fatty Degeneration Index (GFDI) — predicts structural retear and functional outcome. Follow-up was by MRI or CT arthrography at mean 37 months, with functional outcome assessed by Constant score.
A patient with a large rotator cuff tear and advanced fatty infiltration on MRI is not simply a "difficult repair" — they may be a repair that is destined to fail regardless of technique. This paper quantified that reality: every shoulder with a preoperative GFDI above 2 retore, and even a GFDI of 0.5 to 1 carried a 36.5% retear rate.
In clinic, assess the Goutallier grade of all three cuff muscles (supraspinatus, infraspinatus, subscapularis) on preoperative MRI before counseling a patient on repair. When infraspinatus or subscapularis show grade 2 or higher degeneration, caution the patient that retear risk is substantially elevated even if you achieve a technically sound repair.
For patients with GFDI approaching or exceeding 2, this data supports shifting the conversation toward alternative reconstruction (tendon transfer) or reverse shoulder arthroplasty rather than primary repair.
Fatty degeneration does not reverse after repair. This is why prompt surgical referral for tears involving the infraspinatus or subscapularis matters. The window for a favorable repair closes as muscle quality degrades.
Retrospective multicenter study of 220 shoulders undergoing simple tendon-to-bone rotator cuff repair. The study asks whether preoperative fatty degeneration severity — graded with the Goutallier 5-stage system and summarized as a Global Fatty Degeneration Index (GFDI) — predicts structural retear and functional outcome. Follow-up was by MRI or CT arthrography at mean 37 months, with functional outcome assessed by Constant score.
A patient with a large rotator cuff tear and advanced fatty infiltration on MRI is not simply a "difficult repair" — they may be a repair that is destined to fail regardless of technique. This paper quantified that reality: every shoulder with a preoperative GFDI above 2 retore, and even a GFDI of 0.5 to 1 carried a 36.5% retear rate.
In clinic, assess the Goutallier grade of all three cuff muscles (supraspinatus, infraspinatus, subscapularis) on preoperative MRI before counseling a patient on repair. When infraspinatus or subscapularis show grade 2 or higher degeneration, caution the patient that retear risk is substantially elevated even if you achieve a technically sound repair.
For patients with GFDI approaching or exceeding 2, this data supports shifting the conversation toward alternative reconstruction (tendon transfer) or reverse shoulder arthroplasty rather than primary repair.
Fatty degeneration does not reverse after repair. This is why prompt surgical referral for tears involving the infraspinatus or subscapularis matters. The window for a favorable repair closes as muscle quality degrades.