Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?

Abstract

Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI) before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

Predicting Retear after Repair of Full-Thickness Rotator Cuff Tear: Two-Point Dixon MR Imaging Quantification of Fatty Muscle Degeneration—Initial Experience with 1-year Follow-up

“…Hence, in our current study, we focused on postoperative longitudinal changes in fat fractions and in predicting retear using a two-point Dixon MR imaging quantification. There have been several studies (25,26) of the relationship and longitudinal change in fatty degeneration between pre-and postoperative MR imaging involving qualitative methods; our results support previous research that suggests that the preoperative severity of fatty degeneration is associated with an increased rate of retear. It may be reasonable to consider rotator cuff tears of Goutallier stage 3 or 4 as relative contraindications for rotator cuff repair (27).…”

“…Research regarding postoperative longitudinal change in fatty degeneration is conflicting: Some researchers report that fatty degeneration within muscle does not change after repair (6,22), while others contend it improves (25). Furthermore, there have been several reports (5,26) of progression of fatty degeneration even in patients with successful repair.…”

Fatty infiltration of the shoulder: diagnosis and reversibility

“…There is no evidence that muscular atrophy decreases significantly after repair of the tendon but, conversely, the condition will progress, regardless of functional scores and pain 26 . Patients undergoing transosseous repair of chronic massive rotator cuff tears were significantly improved at the final follow-up after the surgery 32 . The number of patients in whom muscle atrophy and fatty infiltration were improved was significantly higher than that in whom the condition was worsened, showing a strong association between preoperative grading of muscle atrophy and fatty infiltration and repair integrity 33 .…”

Changes in Appearance of Fatty Infiltration and Muscle Atrophy of Rotator Cuff Muscles on Magnetic Resonance Imaging After Rotator Cuff Repair: Establishing New Time-Zero Traits

“…1,16,19 To assess rotator cuff muscle recovery after repair, postoperative measurements of fatty infiltration and muscle atrophy have been compared with preoperative values. 1,17,19,20 The rationale for this comparison is based on the idea that rotator cuff muscles do not change because of repair per se. This assumption that surgical outcomes can be based on preoperative and postoperative measures of fatty infiltration and muscle atrophy may be flawed if the surgical repair itself significantly changes these measures at time 0 (Fig 1).…”