Date Published: January 12, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Hiroshi Yamaguchi, Naoki Suenaga, Naomi Oizumi, Yoshihiro Hosokawa, Fuminori Kanaya.
Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier’s classification. Both were assessed on magnetic resonance imaging (MRI) before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.
Arthroscopic and open repair of the rotator cuff yield variable healing rates [1–6]. Large and massive tears are known to have less satisfactory results, because chronic large and massive tears often involve atrophy and fatty degeneration of the muscles [2–6]. On the other hand, recent studies with devised suture techniques report higher healing rates [1, 7]. However, it has been yet unclear whether successful cuff repair shows recovery of atrophy and fatty degeneration of cuff muscles.
We treated 29 shoulders of 29 patients with chronic massive rotator cuff tears by the surface-holding repair technique with transosseous suture  between 2001 and 2007. The criteria for operative repair included (1) at least six months of failed nonoperative treatment, except for the actual trauma, with the patient continuing to complain of subjectively unacceptable pain or disability, or both, (2) patient need/desire to use the arm at or above the level of the head, (3) good motivation to comply with the postoperative treatment regimen, and (4) the absence of moderate-to-marked osteoarthritis (OA). Twenty-four patients and/or their families agreed to undergo follow-up investigations for more than 18 months after the surgery. The follow-up rate was 82.8% (24 of 29 shoulders). There were 17 men and 7 women, with a mean age at the time of surgery of 63.4 years (range, 45–82 years). The preoperative tear size was assessed by Cofield’s classification at the time of the surgery . The torn tendons were of the supraspinatus and infraspinatus in 18 shoulders, the supraspinatus, infraspinatus, and partial subscapularis in 5 shoulders, and the supraspinatus, infraspinatus, and a part of teres minor in 1 shoulder. The average follow-up period was 38.9 months (range, 18–71 months).
Case 1A 72-year-old woman with supraspinatus and infraspinatus tendon tears. MRI was performed preoperatively and 48 months after repair surgery. The JOA score improved from 61 to 94. The repair integrity was type 1 according to Sugaya’s classification. The preoperative and postoperative occupation ratios were 17.3% (grade 4) and 49.5% (grade 3) for the supraspinatus, and 35.3% (grade 3) and 54.8% (grade 2) for the infraspinatus, respectively. Fatty degeneration improved from stage 3 to stage 2 in the supraspinatus, and from stage 3 to stage 2 in the infraspinatus (Figure 4).
Previous studies reported the following important factors determining the repair integrity after rotator cuff repair: tear size , location, presence/absence of atrophy and fatty degeneration in the muscles [16, 17], repair tension, tendon quality, and patient age . Gerber et al. [16, 18] and Goutallier et al. [14, 16, 17] reported that the most significant risk factors for retear are the presence of atrophy and fatty degeneration.