The effect of tear size and nerve injury on rotator cuff muscle fatty degeneration in a rodent animal model

Objectives: Previously, we reported that tissue vitamin D (tVD) in the rotator cuff muscle had strong correlation with pre-operative serum vitamin D (sVD). Furthermore, tVD reflected more on the preoperative muscle power. This study was a follow-up study to evaluate correlations of tVD, vitamin D receptor (VDR), and postoperative sVD with rotator cuff muscle performance, fatty degeneration, healing failure, and functional outcomes at 1 year after rotator cuff repair (RCR). Methods: Between March and October in 2017, 36 patients who underwent RCR were prospectively enrolled and 26 patients were followed at 1 year postoperatively and analyzed. tVD was assessed using liquid chromatography, and the VDR was measured by western blotting. sVD was checked preoperatively, 6 months, and 1 year post-operatively. At 1 year after surgery, isokinetic muscle performance test (IMPT), ASES score and Constant score were evaluated, and MRI was used to analyze fatty degeneration and the healing failure. Results: The mean level of sVD at 1 year post-operatively was 20.5 ± 9.2 ng/ml. Only six patients had normal level of sVD (> 20 ng/ml, 23.1%), while 19 patients had insufficiency (10 - 20 ng/ml, 73.0%), and one patient had defi-ciency (< 10 ng/ml, 3.8%). Lower sVD at pre-operatively had lower sVD at 6 months and 1 year post-operatively (all p < 0.05). Higher pre-operative and 1 year post-operative sVD had less deficiency of IMPT in abduction (pre-operative, post-operative; CC; Abduction, -0.324, -0.395, p = 0.047, 0.041, respectively) How-ever, no correlation was found in deficiency of IMPT in ER, IR (pre-operative, post-operative; CC; ER, IR; 0.025, -0.042; p = 0.926, 0.874, respectively; post-operative; CC; ER, IR; -0.250, -0.157; p = 0.333, 0.548, re-spectively). Although, there was no correlation was found between torque of muscle power at 1 year post-operatively with pre- and post-operative sVD (all p > 0.05), higher tVD had higher torque of abduction (CC: 0.440, p = 0.043), and showed tendency of higher torque of external rotation (ER) (CC: 0.335, p = 0.077). There was no correlation of tVD and sVD with functional outcomes, fatty degeneration and re-tear rate (all p > 0.05). VDR showed no correlation with any variables (all p > 0.05). Conclusions: tVD and sVD showed positive correlation with rotator cuff muscle performance at 1 year after RCR. Regarding lower sVD at pre-operatively had lower sVD at 1 year post-operatively, and considering lower sVD had higher deficiency of muscle power, supplementation of vitamin D to these patients with low sVD would enhance rota-tor cuff muscle performance postoperatively.

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Rat rotator cuff muscle responds differently from hindlimb muscle to a combined tendon-nerve injury

Journal of Orthopaedic Research® ◽

10.1002/jor.22864 ◽

2015 ◽

Vol 33 (7) ◽

pp. 1046-1053 ◽

Cited By ~ 20

Author(s):

Michael R. Davies ◽

Bharat Ravishankar ◽

Dominique Laron ◽

Hubert T. Kim ◽

Xuhui Liu ◽

...

Keyword(s):

Rotator Cuff ◽

Nerve Injury ◽

Rotator Cuff Muscle ◽

Hindlimb Muscle

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Relationship of Tear Size and Location to Fatty Degeneration of the Rotator Cuff

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.h.01746 ◽

2010 ◽

Vol 92 (4) ◽

pp. 829-839 ◽

Cited By ~ 86

Author(s):

H Mike Kim ◽

Nirvikar Dahiya ◽

Sharlene A Teefey ◽

Jay D Keener ◽

Leesa M Galatz ◽

...

Keyword(s):

Rotator Cuff ◽

Fatty Degeneration ◽

Relationship Of ◽

Tear Size

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Reliability of MR Quantification of Rotator Cuff Muscle Fatty Degeneration Using a 2-point Dixon Technique in Comparison with the Goutallier Classification

Academic Radiology ◽

10.1016/j.acra.2017.03.026 ◽

2017 ◽

Vol 24 (11) ◽

pp. 1343-1351 ◽

Cited By ~ 11

Author(s):

Saya Horiuchi ◽

Taiki Nozaki ◽

Atsushi Tasaki ◽

Akira Yamakawa ◽

Yasuhito Kaneko ◽

...

Keyword(s):

Rotator Cuff ◽

Fatty Degeneration ◽

Rotator Cuff Muscle ◽

Goutallier Classification ◽

Mr Quantification

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Role of transplanted bone marrow cells in development of rotator cuff muscle fatty degeneration in mice

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.06.032 ◽

2017 ◽

Vol 26 (12) ◽

pp. 2177-2186 ◽

Cited By ~ 2

Author(s):

Lawrence V. Klomps ◽

Naseem Zomorodi ◽

H. Mike Kim

Keyword(s):

Bone Marrow ◽

Rotator Cuff ◽

Bone Marrow Cells ◽

Fatty Degeneration ◽

Rotator Cuff Muscle ◽

Marrow Cells

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Relationship of Posterior Decentering of the Humeral Head with Tear Size and Fatty Degeneration in Rotator Cuff Tear

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.3.121 ◽

2019 ◽

Vol 22 (3) ◽

pp. 121-127

Author(s):

Jung-Han Kim ◽

Hyeong-Won Seo

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Humeral Head ◽

Fatty Degeneration ◽

Subscapularis Tendon ◽

Tendon Tear ◽

Level Of Evidence ◽

Cuff Tear ◽

Subscapularis Tendon Tear ◽

Tear Size

Background: Posterior decentering is not an uncommon finding on rotator cuff tear patients’ shoulder magnetic resonance imaging. No previous study has reported on the relationship between posterior decentering and rotator cuff tear.Methods: We assessed patients’ rotator cuff tear humeral head positions based on humeral?scapular alignment (HSA). Subjects were classified into centering and decentering groups based on a <2 mm or >2 mm HSA value, respectively. Differences in rotator cuff tear size, degree of tear, and fatty degeneration between the two groups were evaluated.Results: One hundred seventy-five patients (80 males, 95 females; mean age: 59.7 ± 6.5 years old) were selected as subjects (casecontrol study; level of evidence: 3). Tear size, degree of subscapularis tendon tear, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis muscles were significantly different between the two groups (p<0.001, p<0.001, p<0.001).Conclusions: The occurrence of decentering was related to rotator cuff tear size, degree of subscapularis tendon tear, and fatty degeneration of the rotator cuff muscles.

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Relationship of the Sagittal Extent of Rotator Cuff Tears to the Grade of Fatty Degeneration of the Rotator Cuff Muscles

Clinics in Shoulder and Elbow ◽

10.5397/cise.2011.14.2.159 ◽

1970 ◽

Vol 14 (2) ◽

pp. 159-164 ◽

Cited By ~ 1

Author(s):

Joong Bae Seo ◽

Myung Ho Kim ◽

Je Min Yi

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tear ◽

Fatty Degeneration ◽

Rotator Cuff Tears ◽

Cuff Tear ◽

Anteroposterior Diameter ◽

Shoulder Mri ◽

Group 5 ◽

Group 2 ◽

Tear Size

PURPOSE: To investigate the relationship between the size of a rotator cuff tear and the grade of fatty degeneration of the supraspinatus and infraspinatus muscles.MATERIALS AND METHODS: From a database of 541 patients who underwent a shoulder MRI between September 2004 and September 2010, we enrolled 148 patients that had a full-thickness rotator cuff tear. The anteroposterior diameter of the tear was measured in sagittal views on an MRI. The patients were divided into 6 groups reflecting the anteroposterior diameter: group 1 (a width of <10 mm), group 2 (10 mm< or =width<15 mm), group 3 (15 mm< or =width<20 mm), group 4 (20 mm< or =width<25 mm), group 5 (25 mm< or =width<30 mm) and group 6 (a width<30 mm). Fatty degeneration was rated according to Goutallier et al.RESULTS: Fatty degeneration in the supraspinatus and infraspinatus muscles increased with the severity of the rotator cuff tear. The supraspinatus fatty degeneration increased prominently as the tear size increased from 15~19 mm to 20~24 mm and from 25~29 mm to over 30 mm. The infraspinatus fatty degeneration increased prominently as the tear size increased from 25~29 mm to over 30 mm. Seventeen patients had tear widths under 10 mm and 8 patients among them had fatty degeneration of the infraspinatus.CONCLUSION: Fatty degeneration in supraspinatus and infraspinatus muscles increases prominently at specific tear sizes. The presence of tears under 10 mm with infraspinatus fatty degeneration indicates that the infraspinatus tendon may have an anatomical or functional effect even in small tears.

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Pre- and Postoperative Isokinetic Strength Test in Rotator Cuff Tear

Clinics in Shoulder and Elbow ◽

10.5397/cise.2011.14.2.179 ◽

1970 ◽

Vol 14 (2) ◽

pp. 179-186 ◽

Cited By ~ 1

Author(s):

Jin Young Kim ◽

Suk Kee Tae ◽

Do Hyun Yeo ◽

Ho Min Lee ◽

Jong Soo Oh

Keyword(s):

Rotator Cuff ◽

External Rotation ◽

Peak Torque ◽

Fatty Degeneration ◽

Isokinetic Strength ◽

Total Work ◽

Cuff Tear ◽

Isokinetic Muscle Strength ◽

Tear Size

PURPOSE: This study investigated whether (i) isokinetic muscle strength correlated with (ii) anatomical assessment of rotator cuff tear size, fatty degeneration of the supraspinatus muscle or postoperative cuff integrity.MATERIALS & METHODS: Among patients who underwent arthroscopic rotator cuff repair, 32 patients in whom magnetic resonance imaging (MRI) and isokinetic muscle strength tests were performed preoperatively and, at an average of 10 months after repair, took part in this study. We measured the isokinetic strength (peak torque and total work) deficit in external rotation and internal rotation at a 60degrees/sec load.RESULTS: Preoperative isokinetic strength deficits correlated with tear size (p<0.001) but correlated weakly with fatty degeneration of supraspinatus muscle (p<0.001). In patients with healed rotator cuffs, preoperative peak torque and total work deficits were 39% and 62% for external rotation. At final follow up, they were decreased to 17% and 32%, respectively. In the re-tear group, preoperative peak torque and total work deficit were 44% and 61% in external rotation. At final follow up, they were decreased to 23% and 35%, respectively. But there was no significant difference between the two groups (p>0.05).CONCLUSION: Preoperative isokinetic strength correlates with tear size but not fatty degeneration of the supraspintus muscle or postoperative cuff integrity. Postoperative cuff integrity did not have an effect on postoperative isokinetic strength.

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Comparing Clinical Outcomes After Subacromial Spacer Insertion Versus Other Reconstruction Methods in the Treatment of Irreparable Massive Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119869600 ◽

2019 ◽

Vol 7 (9) ◽

pp. 232596711986960

Author(s):

Joo Han Oh ◽

Joo Hyun Park ◽

Hyeon Jang Jeong ◽

Sung-Min Rhee

Keyword(s):

Rotator Cuff ◽

Fatty Degeneration ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tears ◽

Reconstruction Methods ◽

Functional Scores ◽

Group 2 ◽

Tear Size ◽

Group 1

Background: Previous studies on subacromial spacer (SAS) insertion have been limited to case series that did not compare the effectiveness of this technique with other techniques. Hypothesis: Outcomes after SAS insertion for the treatment of irreparable massive rotator cuff tears (IMRCTs) will be similar to those of other techniques. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study was based on data collected from patients who underwent correction of IMRCTs between January 2010 and October 2017. Group 1 patients (n = 17) received SAS insertion with or without partial repair; group 2 patients (n = 36) were treated with other techniques (isolated partial repairs or bridging grafts). Preoperative tear size and global fatty degeneration index values were evaluated. Range of motion, visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Simple Shoulder Test (SST), Disabilities of the Arm, Shoulder and Hand score, and acromiohumeral distance (AHD) were assessed preoperatively and at final follow-up at least 2 years after the surgery (range, 24-60 months). In both groups, ultrasonographic examination was performed at 3 and 6 months postoperatively, and magnetic resonance imaging (MRI) was performed at 1 year. Results: Tear size and preoperative global fatty degeneration index were not significantly different between the groups (all P > .05). There were no differences in functional scores between the groups at final follow-up (all P > .05). AHD was maintained at final follow-up in group 1 (mean ± SD: 6.2 ± 2.1 mm [postoperatively] vs 6.7 ± 2.3 mm [final follow-up]; P = .678), and there was no difference compared with group 2 (7.2 ± 3.2 mm; P = .244). Patients with retears in group 2 (23 of 36, 63.9%) had lower ASES ( P = .041) and SST ( P = .027) scores at final follow-up when compared with patients in group 1. Six patients (35.3%) in group 1 had partial repairs; these patients had better external rotation at 90° ( P = .047), better SST scores ( P = .036), and higher AHDs at final follow-up ( P = .046) than those in group 1 who had no repair. Three patients (50%) showed retears of partially repaired tendons on MRI. Of 13 patients (76.5%) in group 1 with postoperative MRI, 12 (92.3%) showed fibrotic tissue in the subacromial space not seen preoperatively. Conclusion: There was no difference in outcomes between SAS and the other reconstruction methods for treating IMRCTs. However, given the high retear rate associated with other techniques and poor functional outcomes after retear, SAS insertion could be a viable option for treating IMRCTs.

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