This large retrospective series reviewed 1688 surgically treated rotator cuff tears with preoperative CT arthrogram or MRI. It maps the natural history of muscle fatty infiltration using the Goutallier classification. The goal was to define how tear type, patient age, and time since symptom onset drive fatty infiltration onset and severity.
The core decision rule from this paper: repair the cuff before Goutallier stage 2 fatty infiltration develops, because stage 2 or higher is irreversible and predicts permanent function loss and re-tear.
This series gives you concrete timelines to counsel patients. In a full-thickness supraspinatus tear, intermediate FI arrives at roughly 4 years and severe FI at 6 years, so a patient failing conservative care should not linger indefinitely.
The new contribution here is patient age. On regression, age outweighed symptom duration for the supraspinatus and infraspinatus, meaning an older patient with a fresh tear may already have advanced muscle change. The practical mental model: bigger tear plus older patient equals faster, more severe fatty infiltration, so lower your threshold to operate early in that combination.
Remember that FI does not reverse with repair and actually progresses postoperatively, so the muscle you save is the muscle you have going forward.
This large retrospective series reviewed 1688 surgically treated rotator cuff tears with preoperative CT arthrogram or MRI. It maps the natural history of muscle fatty infiltration using the Goutallier classification. The goal was to define how tear type, patient age, and time since symptom onset drive fatty infiltration onset and severity.
The core decision rule from this paper: repair the cuff before Goutallier stage 2 fatty infiltration develops, because stage 2 or higher is irreversible and predicts permanent function loss and re-tear.
This series gives you concrete timelines to counsel patients. In a full-thickness supraspinatus tear, intermediate FI arrives at roughly 4 years and severe FI at 6 years, so a patient failing conservative care should not linger indefinitely.
The new contribution here is patient age. On regression, age outweighed symptom duration for the supraspinatus and infraspinatus, meaning an older patient with a fresh tear may already have advanced muscle change. The practical mental model: bigger tear plus older patient equals faster, more severe fatty infiltration, so lower your threshold to operate early in that combination.
Remember that FI does not reverse with repair and actually progresses postoperatively, so the muscle you save is the muscle you have going forward.