Xie Jianhao, Zhou Meng, Guo Zhe, Zhu Yiming, Jiang Chunyan
Peking University Fourth School of Clinical Medicine, Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China.
Department of Radiology, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, China.
Am J Sports Med. 2025 Mar;53(4):952-960. doi: 10.1177/03635465251313809. Epub 2025 Jan 31.
Preoperative assessment of fatty degeneration is important for managing rotator cuff tears. The Goutallier classification is semiquantitative and observer dependent. Discrepancies among surgeons can be prominent. A quantitative method may improve accuracy and reliability in evaluating the exact percentage of fatty infiltration (Fat%).
HYPOTHESIS/PURPOSE: This study aimed to investigate the correlation between the new quantitative method and the Goutallier classification in assessing fatty infiltration (FI) of the supraspinatus muscle and to explore the use of this method in predicting retear after rotator cuff repair. It was hypothesized that the new method would significantly correlate with the Goutallier classification and be more sensitive to retear.
Cohort study (diagnosis); Level of evidence; 3.
This study included 105 patients who underwent arthroscopic rotator cuff repair for large to massive tears. All patients underwent routine preoperative and 1-year postoperative magnetic resonance imaging and were divided into 2 groups according to tendon healing. Preoperative quantitative Fat% of the supraspinatus muscle was evaluated based on the signal intensity (SI) of the T1-weighted sequence. The Fat% was calculated using the following equation: SI = SI× Fat% + SI× (1 - Fat%). The correlation between the Fat% and the Goutallier grade was determined. Univariate and multivariate analyses were performed to identify the independent risk factors for retear.
The mean preoperative Fat% of the supraspinatus muscle was 23.77 ± 15.96. A significant correlation was found between the Fat% and the Goutallier grade of the supraspinatus muscle ( = 0.655; < .001). The overall retear rate was 21.9%; however, functional status significantly improved regardless of cuff healing. Multivariate analysis identified the Fat% ( = .005) and the modified Patte classification ( = .003) as independent risk factors of retear. The receiver operating characteristic curves showed that the cutoff value of Fat% for predicting retear was 33.2%. Fat% >33.2% possessed superior diagnostic accuracy (79.0%), Youden index (0.513), and positive and negative predictive values (51.6% and 90.5%, respectively) compared with the Goutallier grades.
Although the quantitative method for assessing Fat% of the supraspinatus muscle significantly correlated with the Goutallier classification, the quantitative method is more clinically relevant to retear. Fat% of the supraspinatus muscle >33.2% possessed higher diagnostic value than the Goutallier grades in predicting retear.
术前评估脂肪变性对于处理肩袖撕裂至关重要。Goutallier分级是半定量的且依赖观察者。外科医生之间的差异可能很显著。一种定量方法可能会提高评估脂肪浸润确切百分比（脂肪%）的准确性和可靠性。
假设/目的：本研究旨在探讨新的定量方法与Goutallier分级在评估冈上肌脂肪浸润（FI）方面的相关性，并探索该方法在预测肩袖修复术后再撕裂中的应用。假设新方法将与Goutallier分级显著相关且对再撕裂更敏感。
队列研究（诊断）；证据级别：3。
本研究纳入了105例因大型至巨大型撕裂而接受关节镜下肩袖修复的患者。所有患者均接受了常规术前和术后1年的磁共振成像检查，并根据肌腱愈合情况分为2组。基于T1加权序列的信号强度（SI）评估术前冈上肌的定量脂肪%。脂肪%使用以下公式计算：SI = SI×脂肪% + SI×(1 - 脂肪%)。确定脂肪%与Goutallier分级之间的相关性。进行单因素和多因素分析以确定再撕裂的独立危险因素。
术前冈上肌的平均脂肪%为23.77±15.96。发现脂肪%与冈上肌的Goutallier分级之间存在显著相关性（ = 0.655； <.001）。总体再撕裂率为21.9%；然而，无论袖带愈合情况如何，功能状态均有显著改善。多因素分析确定脂肪%（ = 0.005）和改良的Patte分级（ = 0.003）为再撕裂的独立危险因素。受试者工作特征曲线显示，预测再撕裂的脂肪%临界值为33.2%。与Goutallier分级相比，脂肪%>33.2%具有更高的诊断准确性（79.0%）、约登指数（0.513）以及阳性和阴性预测值（分别为51.6%和90.5%）。
虽然评估冈上肌脂肪%的定量方法与Goutallier分级显著相关，但该定量方法在临床上与再撕裂更相关。冈上肌脂肪%>33.2%在预测再撕裂方面比Goutallier分级具有更高的诊断价值。
