Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Lapner, Peter; Jiang, Liangfu; Zhang, Tinghua; Athwal, George S.

doi:10.1007/s11999-014-3963-5

Cited by 42 publications

(37 citation statements)

References 27 publications

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“…Rotator cuff muscle degeneration and scapulohumeral subluxation are critical parameters when anatomical TSA is intended for primary OA with no rotator cuff tear [1,2]. Given that rotator cuff muscles are responsible for glenohumeral joint stability, their degeneration might induce a loss of this function, and thus eccentric loading of the prosthetic glenoid component, and eventually aseptic loosening [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Rotator cuff muscle degeneration and scapulohumeral subluxation are key elements to consider when planning anatomical total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with no rotator cuff tear [1,2]. Degenerative changes of rotator cuff muscles may induce a loss of joint stability and eventually asymmetric glenoid loading after anatomical TSA [3,4].…”

Section: Introductionmentioning

confidence: 99%

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A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis

Terrier¹,

Ston²,

Dewarrat³

et al. 2017

Orthopaedics & Traumatology: Surgery & Research

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a b s t r a c tBackground: Rotator cuff muscle degeneration is an important parameter to consider when planning shoulder arthroplasty. Hypothesis: We hypothesized that rotator cuff muscle degeneration is correlated with scapulohumeral subluxation in patients planned for anatomical total shoulder arthroplasty (TSA). Materials and methods: We developed a semi-automated quantitative CT method to measure rotator cuff muscle degeneration, and retrospectively analyzed 107 preoperative shoulder CT scans of patients with primary osteoarthritis. On a standardized sagittal-oblique CT slice perpendicular to the scapular axis, two observers measured the cross-sectional areas of residual rotator cuff muscle tissues, normalized by the estimated area of healthy muscles. Muscle degeneration was quantified in a semi-automated manner, and divided into atrophy and fatty infiltration. Scapulohumeral subluxation was determined in 3D as the distance between the humeral head center and the glenoid surface center, projected on the same CT slice, and normalized by the humeral head radius. We tested all potential correlations between muscle degeneration and scapulohumeral subluxation. Results: Muscle degeneration, primarily due to atrophy, predominated in the supraspinatus; it varied from 0.8% to 88.8%. Scapulohumeral subluxation varied from 2.5% to 72.9%, and was mainly in a posterior and postero-superior orientation. There was a significant but weak correlation between the amount of subluxation and both supraspinatus (R = 0.207, P = 0.032) and infraspinatus (R = 0.225, P = 0.020) degeneration. Inter-and intra-observer reproducibility of muscle degeneration measurements were both excellent respectively). Conclusion: This new semi-automated CT method allows to quantitatively and reproducibly measure rotator cuff muscle degeneration in shoulders with primary osteoarthritis. Muscle degeneration is weakly correlated with scapulohumeral subluxation in patients planned for anatomical TSA. Level of evidence: Level IV. Type of study: Diagnostic retrospective study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis

Terrier¹,

Ston²,

Dewarrat³

et al. 2017

Orthopaedics & Traumatology: Surgery & Research

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“…Tear length and width were measured on MRI using the protocol of Davidson et al [ 14 ] FD of the supraspinatus, the infraspinatus/teres minor, and the subscapularis were evaluated on the most lateral oblique sagittal T2-weighted MRI with the scapular body (the “Y-view”) [ 15 , 16 ], using both Goutallier classification system and ImageJ [ 14 ]. The infraspinatus and teres minor were combined into a single measurement, because their borderline was not always clearly confirmed [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for retear of large/massive rotator cuff tears after arthroscopic surgery: an analysis of tearing patterns

et al. 2017

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BackgroundPrevious studies have evaluated the risk factors for retear of large/massive rotator cuff tears (RCTs) that were treated arthroscopically; however, most studies did not evaluate tear patterns. The present study hypothesized that postoperative risk factors are affected by the tearing patterns in large/massive cuff tears in patients undergoing arthroscopic rotator cuff repair (ARCR).MethodsOne hundred fifty patients with large/massive cuff tears underwent ARCR at our institution. Of these, 102 patients were enrolled in this study, with an average symptom duration of 36.3 ± 43.9 months and average age of 63.9 ± 9.4 years. According to the arthroscopic findings and magnetic resonance imaging (MRI), the 102 patients were divided into three groups based on the tendon location: anterosuperior tears (N = 59, group AS), posteosuperior tears (N = 21, group PS), and anteroposterior-extending tears (N = 22, group APE). Functional outcome was evaluated preoperatively and postoperatively using the Japanese Orthopedic Association (JOA) score and the University of California, Los Angeles (UCLA) score. Retear was evaluated with MRI at a minimum of 1 year after surgery, using Sugaya’s classification; Types IV and V were considered postoperative retears. Factors affecting postoperative retear were examined with univariate and multivariate analyses.ResultsJOA/UCLA scores significantly improved postoperatively in the three groups (P < 0.01 for all). Postoperative retear was noted in 26 of 102 patients (25.5%) in this series: 10 patients in group AS (16.9%), 9 in group PS (42.9%), and 7 in group APE (31.8%). The retear rate was significantly higher in group PS than in the other two groups (P = 0.02). Multivariate analysis showed that decreased preoperative active external rotation range was a unique risk factor for postoperative retear in the PS and APE groups (95% confidence interval: 0.02–0.18, cut-off value: 25°, with an area under the curve of 0.90, P = 0.0025).ConclusionsAlthough multivariate analysis failed to detect significant risk factor for retear in patients with anterosuperior large/massive cuff tears who undergo ARCR, it demonstrated that active external rotation less than 25° before surgery is a significant risk factor in those with posterosuperior large/massive tears. This study may help surgeons understand the results of arthroscopic surgery in patients with large/massive tears.

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“…Lapner et al reported significantly increased extent of pre-vs. post-arthroplasty FI using Goutallier grade, as well as an association with lower strength in patients with OA [22]. There have been other studies that show correlations between FI severity and poor surgical outcome [6,7,16,18,19,23,24] . Despite the advances in measuring FI infiltration and its relation to shoulder disease, it is not understood how it occurs in some but not all cuff tears.…”

Section: International Journal Of Orthopaedicsmentioning

confidence: 97%

Fatty Infiltration of Rotator Muscles: A Comparison of Cuff Tear Arthropathy and Glenohumeral Osteoarthritis

Scott¹,

Glowacki²,

Higgins³

2016

International Journal of Orthopaedics

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BACKGROUND:Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis (OA) are age-related chronic diseases of the shoulder representing debilitating, painful conditions with functional loss. Surgical intervention provides the most reliable treatment, but studies have shown that prognosis is contingent upon a variety of factors, one of the most reliable of which is fatty infiltration of the rotator cuff muscles. This study tests the hypothesis that fatty infiltration (FI) is increased in CTA subjects compared with OA subjects. METHODS: CTA subjects (n = 22, age 71.9 ± 7.8 years) and OA subjects (n = 22, age 62.9 ± 9.6 years) were evaluated for extent of fatty infiltration by Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) imaging using Goutallier's classification system and a novel scoring system of % FI. RESULTS: Goutallier classification showed that FI of the supraspinatus and infraspinatus rotator cuff muscles in CTA subjects was greater than those in OA subjects (p = 0.0001, p = 0.003, respectively). The % FI method revealed similar results (p = 0.003, p = 0.0008, respectively). Neither classification system revealed significant differences in FI for the subscapularis or teres minor cuff muscles (Goutallier: p = 0.123, p=0.890; % FI: p = 0.142, p = 0.666, respectively). Analysis using age-matched controls revealed similar results. There was a strong correlation in scores for the two classification systems (Spearman r = 0.96, p < 0.0001). CONCLUSION: Extent of fatty infiltration of the rotator cuff muscles in subjects suffering from rotator cuff tear arthropathy is significantly greater than in subjects with osteoarthritis. Level of evidence: Level IV, Case Controlled.

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Rotator Cuff Fatty Infiltration and Atrophy Are Associated With Functional Outcomes in Anatomic Shoulder Arthroplasty

Cited by 42 publications

References 27 publications

A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis

A semi-automated quantitative CT method for measuring rotator cuff muscle degeneration in shoulders with primary osteoarthritis

Risk factors for retear of large/massive rotator cuff tears after arthroscopic surgery: an analysis of tearing patterns

Fatty Infiltration of Rotator Muscles: A Comparison of Cuff Tear Arthropathy and Glenohumeral Osteoarthritis

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