Should the Rotator Cuff be repaired when there is Fatty Degeneration in the Muscle?
References: Practical Arthroscopy, September 2004
The controversy of fatty degeneration of the supraspinatus muscle associated with rotator cuff tear was discussed by Lafosse and Burkhart. The French feel that fatty degeneration is a relative contra-indication for repair of the cuff.
The classification (Goutallier and Bernageau) of fatty degeneration is this: - Stage 0 - normal muscle - Stage 1 – some fatty streaks - Stage 2 - <50% fat - Stage 3 – 50% fat - Stage 4 0 > 50% fat o Stage 4A – 50-75% fat o Stage 4B - > 75% fat
Lafosse reported results that were only fair/good in stages 3 and 4 of degeneration of the muscle, compared to excellent and good results in stage 1 and 2.
Burkhart and Richards reviewed their results that showed patients with >75% of fatty degeneration had results that were not as good as those with 50-75% fat in the muscle. But, the results in the 50% of fatty degeneration group were satisfactory.