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FATTY INFILTRATION AND ATROPHY OF THE ROTATOR CUFF DO NOT IMPROVE FOLLOWING ROTATOR CUFF REPAIR
Lo et al.
Abstract
Introduction: There has been controversy as to whether
rotator cuff repair (RCR) can improve the fatty infiltration
(FI) and muscle atrophy (MA) often seen in large rotator
cuff tears. This study compares FI and MA see on pre- and
post-operative MRI’s as part of a prospective outcome study of rotator cuff repair.
Methods: The clinical outcome of 39 patients (mean 62yo,
minimum follow-up 1yr) following RCR was determined with
ASES and Constant scores. FI was graded on a 5 point scale and MA on a 4 point scale on pre and post-operative MRI’s.
Results: Pain, function, ASES and Constant scores all
significantly improved following RCR (p<0.05). FI and MA
positively correlated with tear size (p<0.0001, r=0.712),
and those with greater degrees of supraspinatous FI were
more likely to retear (p<0.001, r=0.745). ASES and Constant scores, and strength measurements, all inversely correlated with FI and MA (p<0.03). Strength in FF and ER was affected more by infraspinatous FI than similar levels of the supraspinatous. Pain relief was independent of the severity of FA/MA. Only one patient improved from moderate to mild MA. In 18 MA/FI were unchanged and in 21 MA and/or FI was actually worse.
Conclusion: FI and MA significantly affect the functional
outcome following RCR even though pain is relieved. Neither FI nor MA appear to reverse following surgery, even with a successful outcome, and in moderate to severe cases may actually worsen. Patients’ expectations should not include reversal of muscle degeneration once present.
References
ICSS, Washington, 2004
Comments
It has generally become accepted that fatty infiltration and muscle atrophy adversely effect the retear rate following rotator cuff repair. This study nicely demonstrates that when rotator cuffs with FI and MA are repaired the muscle changes do not reverse 1 year after surgery.
The study also reinforced the following:
1. Tear size correlates with the FI and MA
2. High degrees of supraspinatous FI are
more likely to retear
3. Pain relief is independent of the severity of FI andMA
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