Bokshan Steven L, Tabarestani Troy Q, Ruderman Lindsey, Rueckert Helen, Levin Jay, Leinroth Abigail P, Ibarra Juliana, Klifto Christopher, Hilton Matthew J, Anakwenze Oke
Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Duke University School of Medicine, Durham, NC, USA.
J Shoulder Elbow Surg. 2024 Apr;33(4):e215-e222. doi: 10.1016/j.jse.2023.08.010. Epub 2023 Sep 26.
Fatty accumulation in rotator cuff muscles has been associated with shoulder dysfunction, risk of repair failure, and poor postoperative outcomes. This study sought to assess risk factors associated with true fatty accumulation based on histologic analysis and determine whether preoperative function directly correlated with this fatty rotator cuff accumulation.
Supraspinatus muscle biopsy specimens obtained prospectively from patients undergoing arthroscopic rotator cuff repair were stained with LipidTOX to quantify lipid accumulation. Two-step cluster analysis with Goutallier classification was used to define the fatty and non-fatty rotator cuff groups. We further performed a receiver operating characteristic curve analysis to confirm the group cutoff values.
In total, 51 patients (aged 60.1 ± 10.5 years) were included. There were 19 high-grade partial tears, 10 small tears, 7 medium tears, 10 large tears, and 5 massive tears. Both cluster and receiver operating characteristic curve analyses yielded a cutoff value of 30% LipidTOX/4',6-diamidino-2-phenylindole (DAPI) separating the fatty vs. non-fatty groups. In the univariate analysis, patients with fatty rotator cuffs were aged 63.2 years on average compared with 59.7 years in the non-fatty group (P = .038). Female patients made up 57.1% of the fatty cohort, which was statistically higher than the non-fatty group (P = .042). Massive and large tears were more likely to occur in the fatty group (P = .005). In the multivariate analysis, full tendon tears had the largest predictive status of falling into the fatty group (odds ratio, 15.4; P = .008), followed by female sex (odds ratio, 4.9; P = .036). Patients in the fatty group had significantly higher American Shoulder and Elbow Surgeons scores (P = .048) and lower visual analog scale scores (P = .002).
This prospective histologic assessment revealed that full-thickness rotator cuff tears and female sex were the largest risk factors for intracellular lipid accumulation. Although tear size correlated with fatty accumulation, the sex disparity is a noteworthy finding that warrants further research.
肩袖肌群中的脂肪堆积与肩部功能障碍、修复失败风险及术后不良预后相关。本研究旨在基于组织学分析评估与真性脂肪堆积相关的危险因素，并确定术前功能是否与肩袖脂肪堆积直接相关。
前瞻性地从接受关节镜下肩袖修复的患者获取冈上肌活检标本，用LipidTOX染色以量化脂质堆积。采用两步聚类分析结合Goutallier分类来定义脂肪性和非脂肪性肩袖组。我们进一步进行了受试者工作特征曲线分析以确认分组临界值。
共纳入51例患者（年龄60.1±10.5岁）。其中有19例高度部分撕裂、10例小撕裂、7例中等撕裂、10例大撕裂和5例巨大撕裂。聚类分析和受试者工作特征曲线分析均得出以30%的LipidTOX/4',6-二脒基-2-苯基吲哚（DAPI）作为区分脂肪性和非脂肪性组的临界值。在单因素分析中，脂肪性肩袖患者的平均年龄为63.2岁，而非脂肪性组为59.7岁（P = 0.038）。女性患者占脂肪性队列的57.1%，在统计学上高于非脂肪性组（P = 0.042）。巨大和大撕裂在脂肪性组中更易发生（P = 0.005）。在多因素分析中，全层肌腱撕裂归入脂肪性组的预测地位最高（比值比，15.4；P = 0.008），其次是女性性别（比值比，4.9；P = 0.036）。脂肪性组患者的美国肩肘外科医师评分显著更高（P = 0.048），视觉模拟量表评分更低（P = 0.002）。
这项前瞻性组织学评估显示，肩袖全层撕裂和女性性别是细胞内脂质堆积的最大危险因素。虽然撕裂大小与脂肪堆积相关，但性别差异是一个值得注意的发现，值得进一步研究。
