A Correlation Study of Clinical Outcomes by Quantification of Fatty Degeneration of the Subscapularis: Partial vs. Whole Cross-section
10.5397/cise.2018.21.2.67
- Author:
Joo Hyun PARK
1
;
Kwang Yeol LEE
;
Sung Min RHEE
;
Joo Han OH
Author Information
1. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. ohjh1@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Rotator cuff tear;
Subscapularis;
Fatty;
Degeneration
- MeSH:
Follow-Up Studies;
Humans;
Magnetic Resonance Imaging;
Methods;
Prognosis;
Range of Motion, Articular;
Retrospective Studies;
Rotator Cuff;
Statistics as Topic;
Tears;
Tendons;
Ultrasonography
- From:Clinics in Shoulder and Elbow
2018;21(2):67-74
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Fatty degeneration of rotator cuff is a well-known predictor of postoperative outcome. The purpose of this study was to evaluate the clinical features of rotator cuff tears involving subscapularis, and investigate whether fatty degeneration quantified from only the upper subscapularis correlates better with clinical outcomes than quantified from the whole subscapularis. METHODS: We retrospectively analyzed 315 consecutive patients who underwent arthroscopic repair for rotator cuff tears involving subscapularis with a minimum follow-up of 1 year. Preoperative and postoperative visual analogue score for pain, range of motion and functional scores were assessed. Integrity of the repaired tendon was assessed at the 1-year follow-up with either magnetic resonance imaging or ultrasonography. RESULTS: The mean Goutallier grade of whole cross-section was significantly lower than that of upper cross-section (1.59 vs. 1.71, p<0.05), but significantly higher than that of lower cross-section (1.59 vs. 1.01, p<0.05). In analysis of 37 re-tears, the occupancy of severe fatty degeneration in upper cross-section was 86.5%, which was significantly higher than that seen in whole cross-section (56.8%, p<0.05). We calculated the cut-off tear size for prediction of re-tears as 19.0 mm for retraction and 11.0 mm for superior-inferior. The cut-off Goutallier grade was 2.5 for both whole and upper cross-sections, but area under the curve was greater in the upper cross-section than the whole (0.911 vs. 0.807). CONCLUSIONS: As fatty degeneration of upper subscapularis demonstrated a more distinct spectrum than whole subscapularis, we suggest that measuring fatty degeneration of upper subscapularis can be a more useful method to predict clinical prognosis.
