title: Effect of Fatty degeneration of the infraspinatus on the efficacy of arthroscopic patch autograft procedure for large to massive rotator cuff tears.
abstract: BACKGROUND
  In a 2013 study involving 24 patients whose shoulders had large or massive rotator cuff tears (RCTs) and low-grade fatty degeneration of the infraspinatus (Goutallier stage 1 or 2), we reported significantly improved clinical results after an arthroscopic fascia lata autograft patch procedure, with a 79.2% rate of intact repairs. Based on that study, we began applying the fascia lata autograft patch procedure to shoulders with stage 3 or 4 degeneration of the supraspinatus and stage 3 or 4 degeneration of the infraspinatus.
  
  
  OBJECTIVE
  To investigate the effects of the fascia lata autograft patch procedure on massive RCTs in shoulders with high-grade degeneration of the infraspinatus by comparing the clinical outcomes and structural features with those in shoulders with low-grade degeneration of the infraspinatus.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  A case series of 45 consecutive patients with large to massive RCTs with high-grade fatty degeneration of the supraspinatus and either low-grade (group L; n=26 [the same patients as in our previous study plus 2 additional patients]) or high-grade (group H; n=19) fatty degeneration of the infraspinatus were treated with the fascia lata autograft patch procedure. Clinical (Constant and American Shoulder and Elbow Surgeons [ASES]) scores, structural outcomes on MRI, and muscle strength were assessed at a minimum 2-year follow-up and compared between the 2 groups.
  
  
  RESULTS
  Patients in group L had a higher frequency of intact repairs than did those in group H (73.1% vs 10.6%; P<.001), as assessed by MRI. Clinical scores, range of motion, and muscle strength ratios were improved after surgery in both groups. However, at the final follow-up, the mean Constant (78.4 in group L vs 63.9 in group H; P<.0001) and ASES (91.3 in group L vs 73.6 in group H; P<.001) scores were significantly higher in group L than in group H. Moreover, there were significant between-group differences in the mean muscle strength ratio of the affected to healthy sides for both abduction (0.68 in group L vs 0.54 in group H) and external rotation (0.67 in group L vs 0.50 in group H) for abduction at the final follow-up (P<.0001 for both).
  
  
  CONCLUSIONS
  The arthroscopic fascia lata autograft patch procedure was not as beneficial for massive RCTs with high-grade fatty degeneration of the supraspinatus and infraspinatus as other treatment options that produce similar functional results.
authors: Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan altair.0421@gmail.com.
authors: Daisuke
authors: D
authors: Mori
authors: Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan.
authors: Noboru
authors: N
authors: Funakoshi
authors: Department of Orthopaedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan.
authors: Fumiharu
authors: F
authors: Yamashita
authors: Department of Orthopaedic Surgery, Jyujyo Takeda Rehabilitation Hospital, Kyoto, Japan.
authors: Tsuguru
authors: T
authors: Wakabayashi
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: arthroscopic patch autograft procedure; fatty degeneration; infraspinatus; massive rotator cuff tears