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A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes.

ABSTRACT: Fatty infiltration (FI) of the muscle as graded by the Goutallier classification (GC) is a well-known sequela following rotator cuff injury. The degree to which this predicts the success of rotator cuff repair is unknown.We conducted a systematic review to address the following questions: (1) Does the grade of FI of the rotator cuff muscles present preoperatively predict retear rates postoperatively? (2) Are amounts of preoperative FI predictive of functional outcomes following repair?Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Central Register of Controlled Trials online databases were searched for all literature published between January 1966 and March 2015. Keywords were chosen to achieve a broad search category. All articles were reviewed by three of the authors, and those meeting the study inclusion criteria were selected for data abstraction.The systematic literature review yielded 11 studies reporting on a total of 925 shoulders. Rotator cuffs with moderate or significant FI preoperatively (grades 2-4) had a significantly higher retear rate than those with no or minimal FI (grades 0-1) (59 vs. 25%, p?=?0.045). Four studies reported postoperative Constant scores and preoperative GC scores. One study found that lower GC scores were associated with higher Constant scores postoperatively, one found no association, and the data was inconclusive in the other two.While lower preoperative GC scores are associated with lower rates of rotator cuff retear following repair, there is insufficient data to make conclusions on the effects of FI on functional outcomes following repair.

SUBMITTER: Khair MM

PROVIDER: S-EPMC4916083 | biostudies-other | 2016 Jul

REPOSITORIES: biostudies-other

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A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes.

Khair M Michael MM Lehman Jason J Tsouris Nicholas N Gulotta Lawrence V LV

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20150925 2

<h4>Background</h4>Fatty infiltration (FI) of the muscle as graded by the Goutallier classification (GC) is a well-known sequela following rotator cuff injury. The degree to which this predicts the success of rotator cuff repair is unknown.<h4>Questions/purposes</h4>We conducted a systematic review to address the following questions: (1) Does the grade of FI of the rotator cuff muscles present preoperatively predict retear rates postoperatively? (2) Are amounts of preoperative FI predictive of f ...[more]

PMID: 27385947

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Project description:Background and hypothesisThe impact of preoperative fatty infiltration of specific rotator cuff muscles on the outcomes of reverse total shoulder arthroplasty (rTSA) has not been well defined. Preoperative fatty infiltration of the shoulder musculature will negatively affect rTSA outcomes.MethodsA comprehensive literature review was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses using PubMed, Embase, OVID Medline, Scopus, Cinahl, Web of Science, and Cochrane databases for original, English-language studies evaluating effect of fatty infiltration of shoulder musculature on rTSA outcomes published from January 1, 2000 to present. Blinded reviewers conducted multiple screens. All included studies were graded based on the level of evidence, and data concerning patient demographics and postoperative outcomes were extracted.ResultsA total of 11 articles were included, including one level I article, three level III articles, and seven level IV articles. The review consisted of 720 patients and 731 shoulders (320 women and 157 men), with a mean age of 72.4 years. A single deltopectoral approach was performed for a majority of studies (627/731 shoulders), followed by a superolateral approach (70/731 shoulders) and a single transdeltoid approach (4/731 patients). Eleven studies reported data specifically about preoperative fatty infiltration of the rotator cuff musculature; the teres minor was studied most widely (298/731 shoulders), followed by the subscapularis (256/731 shoulders) and infraspinatus (232/731 shoulders). The Constant score (562/731 shoulders) and American Shoulder and Elbow Surgeons score (284/731 shoulders) were the most common recorded outcome scores. Fatty infiltration of the teres minor, supraspinatus, and infraspinatus was associated with worse range of motion after rTSA.ConclusionPreoperative fatty infiltration of the rotator cuff, particularly of the teres minor and infraspinatus, has a negative impact on subjective patient outcomes and restoration of range of motion, especially external rotation, after rTSA. The impact of fatty infiltration of the other rotator cuff muscles remains unclear, which may be due to intersurgeon differences in the handling of the remaining rotator cuff muscles or differences in implant design. The evaluated literature provides information on which patients can be educated about probable outcomes and restoration of function after rTSA.

Project description:Current evaluation of muscle fatty infiltration has been limited by subjective classifications. Quantitative fat evaluation through magnetic resonance imaging (MRI) may allow for an improved longitudinal evaluation of the effect of surgical repair on the progression of fatty infiltration.We hypothesized that (1) patients with isolated full-thickness supraspinatus tendon tears would have less progression in fatty infiltration compared with patients with full-thickness tears of multiple tendons and (2) patients with eventual failed repair would have higher baseline levels of fatty infiltration.Cohort study; Level of evidence, 2.Thirty-five patients with full-thickness rotator cuff tears were followed longitudinally. All patients received a shoulder MRI, including the iterative decomposition of echoes of asymmetric length (IDEAL) sequence for fat measurement, prior to surgical treatment and at 6 months after surgical repair. Fat fractions were recorded for all 4 rotator cuff muscles from measurements on 4 sagittal slices centered at the scapular-Y. Demographics and tear characteristics were recorded. Baseline and follow-up fat fractions were compared for patients with isolated supraspinatus tears versus multitendon tears and for patients with intact repairs versus failed repairs. Statistical significance was set at P < .05.The mean fat fractions were significantly higher at follow-up than at baseline for the supraspinatus (9.8% ± 7.0% vs 8.3% ± 5.7%; P = .025) and infraspinatus (7.4% ± 6.1% vs 5.7% ± 4.4%; P = .027) muscles. Patients with multitendon tears showed no significant change for any rotator cuff muscle after repair. Patients with isolated supraspinatus tears showed a significant progression in the supraspinatus fat fraction from baseline to follow-up (from 6.8% ± 4.9% to 8.6% ± 6.8%; P = .0083). Baseline supraspinatus fat fractions were significantly higher in patients with eventual failed repairs compared with those with intact repairs (11.7% ± 6.8% vs 7.1% ± 4.8%; P = .037).Contrary to our initial hypothesis, patients with isolated supraspinatus tears showed a significant progression of fatty infiltration. Patients with eventual repair failure had higher baseline fat fractions in the supraspinatus.

Project description:BACKGROUND:Rotator cuff (RC) tears are common tendon injuries seen in orthopaedic patients. Successful repair of large and massive RC tears remains a challenge due to our limited understanding of the pathophysiological features of this injury. Clinically relevant small animal models that can be used to study the pathophysiological response to repair are limited by the lack of chronic repair models. PURPOSE:To develop a highly clinically relevant mouse model of delayed RC repair. STUDY DESIGN:Controlled laboratory study. METHODS:Three-month-old C57BL/6J mice underwent unilateral supraspinatus (SS) and infraspinatus (IS) tendon tear with immediate, 2-week delayed, or 6-week delayed tendon repair. Animals with no repair or sham surgery served as controls. Gait analysis was conducted to measure shoulder function at 2 weeks and 6 weeks after surgery. Animals were sacrificed 6 weeks after the last surgery. Shoulder joint, SS, and IS muscles were harvested and analyzed histologically. Ex vivo mechanical testing of intact and repaired SS and IS tendons was conducted. Reverse-transcriptase polymerase chain reaction was performed on SS and IS muscles to quantify atrophy, fibrosis, and fatty infiltration-related gene expression. RESULTS:Histological and tendon mechanical testing showed that torn tendons could be successfully repaired as late as 6 weeks after transection. However, significant atrophy and fatty infiltration of muscle, with impaired shoulder function, were persistent in the 6-week delayed repair group. Shoulder function correlated with the severity of RC muscle weight loss and fatty infiltration. CONCLUSION:We successfully developed a clinically relevant mouse model of delayed RC repair. Six-week delayed RC repair resulted in persistent muscle atrophy and fatty infiltration with inferior shoulder function compared with acute repair. CLINICAL RELEVANCE:Our novel mouse model could serve as a powerful tool to understand the pathophysiological and cellular/molecular mechanisms of RC muscle and tendon degeneration, eventually improving our strategies for treating and repairing RC tears.

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A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes.

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A Systematic Review of Preoperative Fatty Infiltration and Rotator Cuff Outcomes.

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