Analysis of the Change in Fatty Degeneration of the Rotator Cuff and Its Influence on the Outcome of Rotator Cuff Repair

Jung-Suk Song; Jae-Myeung Chun; Jae-Bum Park; Se-Jun Chung; Tae-Han Kim

doi:10.4055/jkoa.2009.44.5.556

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Song, Chun, Park, Chung, and Kim: Analysis of the Change in Fatty Degeneration of the Rotator Cuff and Its Influence on the Outcome of Rotator Cuff Repair

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2009; 44(5): 556-564.

Published online: 23 September 2009

DOI: https://doi.org/10.4055/jkoa.2009.44.5.556

Analysis of the Change in Fatty Degeneration of the Rotator Cuff and Its Influence on the Outcome of Rotator Cuff Repair

Jung-Suk Song, M.D., Jae-Myeung Chun, M.D., Jae-Bum Park, M.D., Se-Jun Chung, M.D., Tae-Han Kim, M.D.

Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea.

Correspondence to Jae-Bum Park, M.D. Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, Ulsan University, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82.2-3010-3530, Fax: +82.2-488-7877, jbpark2@gmail.com

Received 10 June 2009 Accepted 25 August 2009

Abstract

Purpose

To analyze the changes in fatty degeneration of the rotator cuff after its repair as well as the effect of fatty degeneration on the functional and anatomical outcomes.

Materials and Methods

The medical records of 107 patients (mean age=58.7 years), who had undergone a repair of rotator cuff tears, were reviewed. The mean follow-up period was 16 months. The following parameters were evaluated: the functional outcomes, including the American shoulder and elbow surgeons (ASES) score, Constant score and muscle power; preoperative and postoperative fatty degeneration of the rotator cuffs, including supraspinatus, infraspinatus and subscapularis; and the cuff integrity.

Results

Both the ASES and Constant scores were improved significantly postoperatively. The re-tear rate was 19.6%. The overall rate of satisfactory results was 88.8%. Fatty degeneration progressed in 25 cases (22.4%) and regressed in three (2.8%). More progression was observed in older (p=0.016) and re-tear (p=0.011) patients. The ASES score had a significant relationship with the preoperative fatty degeneration of the supraspinatus and the infraspinatus, whereas the Constant score was associated with the fatty degeneration of all three muscles.

Conclusion

Greater progression of fatty degeneration was observed in older and re-tear patients. The functional outcomes were better in the less severe fatty degeneration group.

Keywords: Rotator cuff tear, Fatty degeneration, Repair of rotator cuff

Figures and Tables

Fig. 1

Regressed fatty degeneration of the infraspinatus in 63-years old woman. (A) Preoperative oblique sagittal image shows grade 2 fatty degeneration in the upper part of the infraspinatus with mild muscle atrophy. (B) Postoperative image shows regression to grade 1.

Table 1

Preoperative and Postoperative Functional Outcomes

Table 2

Preoperative and Postoperative Fatty Degeneration

GFDI, global fatty degeneration index.

Table 3

Three Cases of Regression of Fatty Degeneration of the Rotator Cuffs

Table 4

Changes of Fatty Degeneration according to the Age

Table 5

Changes of the Fatty Degeneration according to the Anatomical Continuity of the Cuff

Table 6

Relationship between the Fatty Degeneration and Functional Outcomes

PCC, Pearson Correlation coefficient; GFDI, global fatty degeneration index.

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