J Am Acad Orthop Surg. 2013 Oct;21(10):613-23. doi: 10.5435/JAAOS-21-10-613.
Moderate to severe fatty infiltration and rotator cuff atrophy are commonly associated with poor clinical outcomes and failed rotator cuff repair. Numerous animal and human studies have attempted to elucidate the etiology of fatty infiltration and rotator cuff atrophy. Mechanical detachment of the tendon in rotator cuff tears is primarily responsible. Suprascapular nerve injury may also play a role. CT, MRI, and ultrasonography are used to evaluate severity. The Goutallier staging system is most commonly used to evaluate fatty infiltration, and rotator cuff atrophy is measured using multiple techniques. The presence and severity of fatty infiltration have been associated with increasing age, tear size, degree of tendon retraction, number of tendons involved (ie, massive tears), suprascapular neuropathy, and traumatic tears. Fatty infiltration is irreversible and progressive if left untreated. Slight reversal of muscle atrophy has been noted after repair in some studies. Novel therapies are currently being evaluated that may eventually allow clinicians to alter the natural history and improve patient outcomes.
中度至重度脂肪浸润和肩袖萎缩通常与不良的临床结果和肩袖修复失败有关。许多动物和人体研究试图阐明脂肪浸润和肩袖萎缩的病因。肩袖撕裂中肌腱的机械分离是主要原因。肩胛上神经损伤也可能起作用。CT、MRI 和超声用于评估严重程度。Goutallier 分期系统最常用于评估脂肪浸润，而使用多种技术测量肩袖萎缩。脂肪浸润的存在和严重程度与年龄增长、撕裂大小、肌腱回缩程度、受累肌腱数量（即巨大撕裂）、肩胛上神经病和创伤性撕裂有关。如果不治疗，脂肪浸润是不可逆转和进行性的。一些研究中注意到修复后肌肉萎缩有轻微逆转。目前正在评估新的治疗方法，这些方法最终可能使临床医生改变自然病程并改善患者的预后。
