Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy.
BMC Musculoskelet Disord. 2023 Feb 16;24(1):127. doi: 10.1186/s12891-023-06237-9.
Macroscopic alterations of the affected rotator cuff (RC) are undoubtedly linked to microscopic changes, but they may underestimate the actual degree of the disease. Moreover, it remains unclear whether preoperative structural RC changes may alter clinical outcomes.
Supraspinatus tendon and muscle samples were collected from 47 patients undergoing RC surgery. Tendons were evaluated histologically according to the Bonar score; fatty infiltration and muscle atrophy were quantified using a software for biomedical image analysis (ImageJ) in percentage of area affected in the observed muscle section. Preoperative shoulder ROM and pain were evaluated. Radiological muscle atrophy was evaluated with the Tangent Sign and Occupation Ratio; fatty infiltration was assessed according to the Goutallier classification. Correlations between histological, radiological and clinical outcomes were assessed. Statistics were performed using the Spearman correlation coefficient. Intraobserver and interobserver agreement was calculated.
Histopathologic fatty infiltration (r = 0.007, p = 0.962), muscle atrophy (r = 0.003, p = 0.984) and the total Bonar score (r = 0.157, p = 0.292) were not correlated to preoperative shoulder pain. Muscle atrophy showed a significant but weak negative correlation with the preoperative movement of abduction (r = -0.344, p = 0.018). A significant but weak positive correlation was found between muscle atrophy and the total Bonar score (r = 0.352, p = 0.015). No correlation between histological and radiological evaluation was found for both fatty infiltration (r = 0.099, p = 0.510) and muscle atrophy (Tangent Sign: r = -0.223, p = 0.131; Occupation Ratio: r = -0.148, p = 0.319). Our histological evaluation showed a modal value of 3 (out of 3) for fatty infiltration and an equal modal value of 2 and 3 (out of 3) for muscle atrophy. In contrast, the modal value of the Goutallier score was 1 (out of 4) and 28 patients out of 47 showed a negative Tangent sign. At histology, intraobserver agreement ranged from 0.59 to 0.81 and interobserver agreement from 0.57 to 0.64. On the MRI intraobserver agreement ranged from 0.57 to 0.71 and interobserver agreement ranged from 0.53 to 0.65.
Microscopic muscle atrophy appeared to negatively correlate with the movement of abduction leading to functional impairment. Shoulder pain did not show any relationship with microscopic changes. Radiological evaluation of the supraspinatus muscle alterations seemed to underestimate the degree of the same abnormalities evaluated at histology.
受影响的肩袖（RC）的宏观改变无疑与微观变化有关，但它们可能低估了疾病的实际程度。此外，目前尚不清楚术前 RC 结构变化是否会改变临床结果。
从 47 例行 RC 手术的患者中采集冈上肌腱和肌肉样本。肌腱根据 Bonar 评分进行组织学评估；使用生物医学图像分析软件（ImageJ）以受观察肌肉节段中受影响面积的百分比量化脂肪浸润和肌肉萎缩。评估术前肩部活动度和疼痛。使用切线征和占用比评估放射学肌肉萎缩；根据 Goutallier 分类评估脂肪浸润。评估组织学、放射学和临床结果之间的相关性。使用 Spearman 相关系数进行统计分析。计算组内和组间一致性。
组织病理学脂肪浸润（r=0.007，p=0.962）、肌肉萎缩（r=0.003，p=0.984）和总 Bonar 评分（r=0.157，p=0.292）与术前肩部疼痛无关。肌肉萎缩与术前外展运动呈显著但微弱的负相关（r=-0.344，p=0.018）。肌肉萎缩与总 Bonar 评分呈显著但微弱的正相关（r=0.352，p=0.015）。组织学和影像学评估之间均未发现脂肪浸润（r=0.099，p=0.510）和肌肉萎缩（切线征：r=-0.223，p=0.131；占用比：r=-0.148，p=0.319）之间存在相关性。我们的组织学评估显示脂肪浸润的模态值为 3（3 分制），肌肉萎缩的模态值相等，为 2 和 3（3 分制）。相比之下，Goutallier 评分的模态值为 1（4 分制），47 名患者中有 28 名出现负切线征。在组织学上，组内一致性范围为 0.59 至 0.81，组间一致性范围为 0.57 至 0.64。在 MRI 上，组内一致性范围为 0.57 至 0.71，组间一致性范围为 0.53 至 0.65。
微观肌肉萎缩似乎与导致功能障碍的外展运动呈负相关。肩部疼痛与微观变化之间没有关系。对冈上肌改变的放射学评估似乎低估了在组织学上评估的相同异常程度。
