Elsevier

Journal of Shoulder and Elbow Surgery

Volume 16, Issue 6, November–December 2007, Pages 691-696
Journal of Shoulder and Elbow Surgery

Original article
Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: A study in thirteen patients

https://doi.org/10.1016/j.jse.2007.02.122Get rights and content

In 13 patients, the development of supraspinatus muscle atrophy and fatty infiltration after rotator cuff tendon repair was quantified prospectively via magnetic resonance imaging. Intraoperative electrical nerve stimulation at repair showed that the maximal supraspinatus tension (up to 200 N) strongly correlated with the anatomic cross-sectional muscle area and with muscle fatty infiltration (ranging from 12 N/cm2 in Goutallier stage 3 to 42 N/cm2 in Goutallier stage 0). Within 1 year after successful tendon repair (n = 8), fatty infiltration did not recover, and atrophy improved partially at best; however, if the repair failed (n = 5), atrophy and fatty infiltration progressed significantly. The ability of the rotator cuff muscles to develop tension not only correlates with their atrophy but also closely correlates with their degree of fatty infiltration. With current repair techniques, atrophy and fatty infiltration appear to be irreversible, despite successful tendon repair. Unexpectedly, not only weak but also very strong muscles are at risk for repair failure.

Section snippets

Materials and methods

Written consent to participate in this study, which had been approved by the institutional review board responsible for our institution, was obtained from 13 consecutive patients, 3 women and 10 men, with a mean age of 56 ± 7 years (range, 41-68 years), with a full-thickness supraspinatus tear requiring repair. None of the patients had any prior operation about the shoulder, had signs or symptoms of infection, was taking steroids or immunosuppressive medication, or had other relevant

Results

At repair, all 13 patients had a full-thickness tear of the supraspinatus tendon. There was an additional partial or complete lesion of the infraspinatus tendon in 5 patients and of the subscapularis tendon in 4 (Table I). The degree of fatty infiltration of the respective muscles varied from stage 0 to 315, 17 (Table II). At the time of postoperative MRI, there were 5 retears of the supraspinatus tendon and 2 retears and 1 new partial tear of the infraspinatus, which all occurred within 6

Discussion

It has previously been documented that chronic changes of the rotator cuff muscles, such as fibrosis and fatty infiltration, lead to loss of elasticity and reparability of the affected muscles.13, 21 These changes also lead to loss of maximal twitch tension and to increased fatigability of the muscle in experimental animal models.1, 6, 24 Our data showed that increasing fatty infiltration of the human supraspinatus muscle was associated with a decrease in contractile force. Loss of force is,

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    This study has been supported by a grant from the ResOrtho Foundation, Zurich, Switzerland.

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