title: Does preoperative subscapularis fatty muscle infiltration really matter in anterosuperior rotator cuff tears repair outcomes? A prospective multicentric study.
abstract: BACKGROUND
  Anterosuperior (AS) rotator cuff tear describes a combined tear of the subscapularis and the supraspinatus tendons. We hypothesized that results after AS tendon repairs might be influenced by the size of the subscapularis rupture and the preoperative subscapularis muscle fatty infiltration.
  
  
  METHODS
  A prospective multicentric study of 53 AS rotator cuff tears from five centers was performed (January 2008-January 2009). Subscapularis tendon retraction and fatty infiltration were assessed preoperatively. An ultrasonographic healing control was performed 1 year after surgery.
  
  
  RESULTS
  Patients were on average 60 years (range, 43-75 years) and were operated on average 16 months (range, 2-72 months) after the beginning of their symptoms. The incidence of AS tears was found to be 18%. Average follow-up was 15 months (range, 12-24). The Constant-Murley (CM) score for the patients with AS ruptures improved significantly from 49 points (range, 35-51 points) preoperatively to 73 points postoperatively (range, 50-95 points)(P=0.0205). CM score gains were 26 for Lafosse group 1 ruptures and 29 for Lafosse group 2 & 3 with pre- and postoperative P values at P<0.0000001 and P<0.000001, respectively. The last follow-up CM score according to the subscapularis fatty infiltration was 70 (range, 48-95) for groups 0-1, 70 (range, 56-87) for group 2, and 56 (range, 53-88) for groups 3-4 with pre- and postoperative P values at P<0.001, P<0.001, and P<0.004, respectively. The global retear rate was 6%.
  
  
  CONCLUSIONS
  Our study showed that the CM score after repairs of AS rotator cuff tears was lower in advanced subscapularis fatty infiltration. However, gains in CM scores were similar whatever the initial subscapularis fatty infiltration. The rate of tendon healing was correlated with subscapularis fatty infiltration. Subscapularis tendon rupture size was not significantly correlated with outcomes.
  
  
  METHODS
  Level III.
authors.affiliation: Clinique Jouvenet, 6, square Jouvenet, 75016 Paris, France. Electronic address: ali.maqdes@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Maqdes
authors.affiliation: Clinique Jouvenet, 6, square Jouvenet, 75016 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Abarca
authors.affiliation: Clinique Jouvenet, 6, square Jouvenet, 75016 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Moraiti
authors.affiliation: Hôpital Privé Armand-Brillard, 3-5, avenue Watteau, 94130 Nogent-sur-Marne, France.
authors.forename: O
authors.initials: O
authors.lastname: Boughebri
authors.affiliation: Clinique la Montagne, 10, rue de la Montage, 92400 Courbevoie, France.
authors.forename: C
authors.initials: C
authors.lastname: Dib
authors.affiliation: Institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
authors.forename: F M
authors.initials: FM
authors.lastname: Leclère
authors.affiliation: Clinique de L'Union, boulevard Ratalens, 31240 Saint-Jean, France.
authors.forename: J
authors.initials: J
authors.lastname: Kany
authors.affiliation: Institut Chirurgical de la Main et du Membre Supérieur, 17, avenue Condorcet, 69100 Villeurbanne, France.
authors.forename: K
authors.initials: K
authors.lastname: Elkolti
authors.affiliation: Clinique du Parc, 155 ter, boulevard de Stalingrad, 69006 Lyon, France.
authors.forename: J
authors.initials: J
authors.lastname: Garret
authors.affiliation: Clinique du Ter, chemin de Kerbernès, 56270 Ploemeur, France.
authors.forename: D
authors.initials: D
authors.lastname: Katz
authors.affiliation: Clinique Jouvenet, 6, square Jouvenet, 75016 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Valenti
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000473:pathology*; D017060:Patient Satisfaction; D057234:Preoperative Period; D011446:Prospective Studies; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D014057:Tomography, X-Ray Computed; D014945:Wound Healing
keywords: Muscle fatty infiltration; Rotator cuff; Shoulder joint