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PROSPECTIVE LONGITUDINAL ANALYSIS OF ATROPHY AND FATTY DEGENERATION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR

Authors: M Kusma; T Grub; M Dienst; D Kohn; O Steimer;

References: Presented at SECEC 2009

Purpose
The objective of this study was to determine the changes in atrophy and fatty degeneration of the muscles of the rotator cuff after arthroscopic repair.

Material and Methods
20 patients with full thickness rotator cuff tears scheduled for arthroscopic rotator cuff repair were included. An MRI was done preoperatively and 6, 12, 26 and 52 weeks postoperatively following a standardized protocol. Tendon retraction (Patte), fatty degeneration (Goutallier), atrophy (Thomazeau) and tendon integrity were analyzed. Additionally, for correlation with the clinical results, preoperatively and 6, 12, 26 and 52 weeks postoperatively, the Constant and Murley Score (CMS) and the Simple Shoulder Test (SST) were evaluated.

Results
Out of the 20 included patients, results of at least 6 months postoperatively are available for 15 patients to date. The CMS increased significantly from preoperatively 62.7 ± 25.5 to 94.8 ± 29.6 postoperatively (p = 0.001). The SST improved significantly from 4.7 preoperatively to 9.1 postopertively (p<0.001). Patients with a limited retraction of the tendons (Patte 1) showed significantly better results in the CMS compared to patients with a higher degree of retraction (Patte 2-3) (118.8 ± 21.2 vs. 78.6 ± 23.8 ; p = 0.01). A significant correlation between the preoperative diameter of the supraspinatus muscle and the postoperative CMS could be found (r = 0.78 ; p = 0.001), showing significantly better results in patients with less preoperative atrophy of the supraspinatus muscle. Between the preoperative MRI and the MRI after 52 weeks, an increase of atrophy was shown which was not statistically significant (p = 0.09). In one patient, a retear was found in the MRI after 26 weeks.

Conclusion
Rotator cuff repair is a successful procedure with respect to pain relief and functional outcome. The tear size and the muscle quality significantly influence the postoperative results. No reversibility of fatty degeneration and atrophy could be found. In contrast, an increase of the muscle atrophy was shown.

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