The modified Goutallier classification system describes the fatty infiltration of rotator cuff musculature (RCM) seen on magnetic resonance imaging (MRI) to assist with surgical decision-making for patients with rotator cuff tears (RCT). We describe the relationship between body mass index (BMI) and fatty infiltration in patients without RCT.
Methods
Twenty-five patients from each of four different BMI ranges (< 25 kg/m2; 25 kg/m2 to 30 kg/m2; 30 kg/m2 to 35 kg/m2; > 35 kg/m2) were randomly selected from 1088 consecutive shoulder MRI scans (T1 parasagittal series). Four physician-readers evaluated MRI scans and assigned modified Goutallier grades (0 to 4) in each of the four rotator cuff muscles, as well as two adjacent muscles.
Results
Grade distributions varied significantly based on BMI category for infraspinatus (p = 0.001), teres minor (p < 0.001), subscapularis (p = 0.025), teres major (p < 0.001) and deltoid (p < 0.001). Higher grades were evident with a diagnosis of diabetes mellitus in three of six muscles (p < 0.05), hyperlipidaemia in one muscle (p = 0.021) and greater patient age in three muscles (p < 0.05).
Conclusions
Obese and severely obese patients without RCT have more fatty infiltration seen on MRI. Patient factors (older age and diagnosis of diabetes mellitus) can be predictive of fatty infiltration in RCM. Fatty infiltration of RCM is not solely attributable to the presence of a RCT.
BeelerSEkETGerberC. A comparative analysis of fatty infiltration and muscle atrophy in patients with chronic rotator cuff tears and suprascapular neuropathy. J Shoulder Elbow Surg2013; 22: 1537–1546.
2.
FuchsBGilbartMKHodlerJGerberC. Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff. J Bone Joint Surg Am2006; 88: 309–316.
3.
GerberCFuchsBHodlerJ. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am2000; 82: 505–515.
4.
GerberCSchneebergerAGHoppelerHMeyerDC. Correlation of atrophy and fatty infiltration on strength and integrity of rotator cuff repairs: a study in thirteen patients. J Shoulder Elbow Surg2007; 16: 691–696.
5.
MeyerDCHoppelerHvon RechenbergBGerberC. A pathomechanical concept explains muscle loss and fatty muscular changes following surgical tendon release. J Orthop Res2004; 22: 1004–1007.
6.
FermontAJWolterbeekNWesselRNBaeyensJPde BieRA. Prognostic factors for recovery after arthroscopic rotator cuff repair: a prognostic study. J Shoulder Elbow Surg2015; 24: 1249–1256.
7.
GasbarroGYeJNewsomeHet al.Morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs: tear size, location, and atrophy matter. Arthroscopy2016; 32: 1947–1952.
8.
GladstoneJNBishopJYLoIKFlatowEL. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med2007; 35: 719–728.
9.
GoutallierDPostelJMGleyzePLeguillouxPVan DriesscheS. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg2003; 12: 550–554.
10.
WarnerJJHigginsLParsonsIMDowdyP. Diagnosis and treatment of anterosuperior rotator cuff tears. J Shoulder Elbow Surg2001; 10: 37–46.
11.
MelisBDeFrancoMJChuinardCWalchG. Natural history of fatty infiltration and atrophy of the supraspinatus muscle in rotator cuff tears. Clin Orthop Relat Res2010; 468: 1498–1505.
12.
MelisBWallBWalchG. Natural history of infraspinatus fatty infiltration in rotator cuff tears. J Shoulder Elbow Surg2010; 19: 757–763.
13.
FuchsBWeishauptDZanettiMHodlerJGerberC. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg1999; 8: 599–605.
14.
OgdenCLCarrollMDFlegalKM. Prevalence of obesity in the United States. JAMA2014; 312: 189–190.
15.
FermontAJWolterbeekNWesselRNBaeyensJPde BieRA. Prognostic factors for successful recovery after arthroscopic rotator cuff repair: a systematic literature review. J Orthop Sports Phys Ther2014; 44: 153–163.
16.
KluczynskiMABissonLJMarzoJM. Does body mass index affect outcomes of ambulatory knee and shoulder surgery?Arthroscopy2014; 30: 856–865.
17.
WarrenderWJBrownOLAbboudJA. Outcomes of arthroscopic rotator cuff repairs in obese patients. J Shoulder Elbow Surg2011; 20: 961–967.
18.
NamdariSBaldwinKGlaserDGreenA. Does obesity affect early outcome of rotator cuff repair?J Shoulder Elbow Surg2010; 19: 1250–1255.
GoutallierDPostelJMBernageauJLavauLVoisinMC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res1994; 304: 78–83.
21.
GoutallierDPostelJMLavauLBernageauJ. [Impact of fatty degeneration of the suparspinatus and infraspinatus msucles on the prognosis of surgical repair of the rotator cuff]. Rev Chir Orthop Reparatrice Appar Mot1999; 85: 668–676.
22.
WilliamsMDLadermannAMelisBBarthelemyRWalchG. Fatty infiltration of the supraspinatus: a reliability study. J Shoulder Elbow Surg2009; 18: 581–587.
23.
Goutallier D, Bernageau J, Patte D. Assessment of the trophicity of the muscles of the ruptured rotator cuff by CT scan. In: Post M, Morrey BF and Hawkins RJ, eds. Surgery of the shoulder. St Louis, Missouri: Mosby, 1990:11–13.
24.
ChungSWParkHKwonJChoeGYKimSHOhJH. Effect of hypercholesterolemia on fatty infiltration and quality of tendon-to-bone healing in a rabbit model of a chronic rotator cuff tear: electrophysiological, biomechanical, and histological analyses. Am J Sports Med2016; 44: 1153–1164.
25.
RazYHenselerJFKolkAet al.Patterns of age-associated degeneration differ in shoulder muscles. Front Aging Neurosci2015. doi:10.3389/fnagi.2015.00236.
26.
RazYHenselerJFKolkAet al.Molecular signatures of age-associated chronic degeneration of shoulder muscles. Oncotarget2016; 7: 8513–8523.
27.
ThankamFGDilisioMFAgrawalDK. Immunobiological factors aggravating the fatty infiltration on tendons and muscles in rotator cuff lesions. Mol Cell Biochem2016; 417: 17–33.
28.
LuanTLiuXEasleyJTRavishankarBPuttlitzCFeeleyBT. Muscle atrophy and fatty infiltration after an acute rotator cuff repair in a sheep model. Muscles Ligaments Tendons J2015; 5: 106–112.
29.
LiuXJoshiSKSamaghSPet al.Evaluation of Akt/mTOR activity in muscle atrophy after rotator cuff tears in a rat model. J Orthop Res2012; 30: 1440–1446.
30.
JoshiSKLiuXSamaghSPet al.mTOR regulates fatty infiltration through SREBP-1 and PPARgamma after a combined massive rotator cuff tear and suprascapular nerve injury in rats. J Orthop Res2013; 31: 724–730.
31.
EvansRMBarishGDWangYX. PPARs and the complex journey to obesity. Nat Med2004; 10: 355–361.
32.
Vidal-PuigAJimenez-LinanMLowellBBet al.Regulation of PPAR gamma gene expression by nutrition and obesity in rodents. J Clin Invest1996; 97: 2553–2561.
33.
OhJHKimSHChoiJAKimYOhCH. Reliability of the grading system for fatty degeneration of rotator cuff muscles. Clin Orthop Relat Res2010; 468: 1558–1564.
34.
LandisJRKochGG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics1977; 33: 363–374.
35.
SlabaughMAFrielNAKarasVRomeoAAVermaNNColeBJ. Interobserver and intraobserver reliability of the Goutallier classification using magnetic resonance imaging: proposal of a simplified classification system to increase reliability. Am J Sports Med2012; 40: 1728–1734.
36.
SchieferMMendoncaRMagnaniniMMet al.Intraobserver and interobserver agreement of Goutallier classification applied to magnetic resonance images. J Shoulder Elbow Surg2015; 24: 1314–1321.
