Arthroscopic Repair of Massive Rotator Cuff Tears With Stage 3 and 4 Fatty Degeneration

Classifications in Brief: Goutallier Classification of Fatty Infiltration of the Rotator Cuff Musculature

“…The classification also has been used to define conditions for inclusion or exclusion in studies [3]. In addition, Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.…”

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

“…5,12 Although the optimal timing for surgical intervention is a contentious issue, there is evidence that surgical repair of full thickness tears results in more favorable outcomes for pain, strength and function. [13][14][15] Medium size rotator cuff tears are also of clinical significance, and identification of these lesions may affect decisions regarding use of diagnostic imaging and influence rehabilitation decisions within conservative management programs. Studies investigating the natural history of rotator cuff tears have shown that, in contrast to small tears with little or no tendon retraction that rarely progress in size, 16 medium sized partial-thickness rotator cuff tears, particularly those involving the articular surface of the cuff, frequently increase in size over time.…”

Role of fatty infiltration in the pathophysiology and outcomes of rotator cuff tears

“…However, the grading system is not without its limitations. Clinical improvement has been reported in a small series of repairs involving massive tears with grade 3 or 4 FI of the infraspinatus that were predicted likely to fail by the Goutallier grade (26). A correlation has been described between the preoperative global fatty degeneration index, which measures the mean value of the Goutallier grades for the supraspinatus, infraspinatus, and subscapularis muscles, and the recurrence of tears at up to 9 years (23).…”

“…In contrast, Jost el al found that neither preoperative supraspinatus nor infraspinatus FI predicted clinical outcomes, but postoperative FI could be used to predict clinical outcomes (31). Significant clinical improvement assessed using UCLA scores has been reported following arthroscopic repairs of tears associated with even severe fatty changes, although greater improvement is seen if FI affects 50 -75%, rather than more than 75%, of the tendon (26).…”