Abstract：
BACKGROUND: Surgically repairing rotator cuff tears with a higher extent of fatty infiltration is controversial. Current evidence supports performing rotator cuff repair in patients exhibiting Goutallier stage 3-4 fatty infiltration. However, the presence of retraction complicates accurate assessment using the Goutallier Classification, particularly on the lateral Y-view. A shift towards classifying fatty infiltration in more medial regions may enhance the precision of tissue quality quantification. The objective of this study was to analyze the uniformity of fatty infiltration within the entire supraspinatus muscle using the Goutallier Classification across three scapular Y-view sections and to examine the association between Goutallier grade, tangent sign, and modified Patte stage.
METHODS: A retrospective evaluation was conducted on preoperative magnetic resonance imaging (MRI) scans from a consecutive series of 97 patients who had previously undergone arthroscopic rotator cuff repairs. Three supraspinatus sections on the MRI sagittal plane were identified: the lateral Y-view (section one), a medial section at the suprascapular notch anatomical landmark (section two), and a section 3 cm medial from the suprascapular notch Medial Scapular Body (section three). Goutallier grade, tangent sign, and modified Patte stage were used to evaluate fatty infiltration, muscle atrophy, and tendon retraction, respectively.
RESULTS: Section one had the highest Goutallier grade, while section three had the lowest. Intra-observer rest retest reliability analysis showed excellent consistency in all sections with section one (ICC=0.920, 95% CI), section two (ICC=0.917, 95% CI), and section three (ICC=0.923, 95% CI) for Goutallier grade. Inter-observer reliability analysis also revealed excellent consistency in sections one (ICC=0.951, 95% CI), section two (ICC=0.949, 95% CI), and section three (ICC=0.922, 95% CI) for Goutallier grade. A strong correlation was observed between Goutallier grade and modified Patte stage (τb=0.43-0.56, p=0.001), and between Goutallier grade and tangent sign (τb=0.43-0.54, p=0.001) across all sections.
CONCLUSIONS: The severity of fatty infiltration within the supraspinatus muscle belly is inconsistent, with the lateral portion being the most severe and the medial portion the least severe. Goutallier grade demonstrates a strong correlation with tangent sign and modified Patte stage. This suggests that tendon retraction results in a potential overestimation in the amount of fatty infiltration defining some tears unjustly irreparable when measuring at the traditionally described lateral Y-view position compared with 3cm medial.
METHODS: A retrospective evaluation was conducted on preoperative magnetic resonance imaging (MRI) scans from a consecutive series of 97 patients who had previously undergone arthroscopic rotator cuff repairs. Three supraspinatus sections on the MRI sagittal plane were identified: the lateral Y-view (section one), a medial section at the suprascapular notch anatomical landmark (section two), and a section 3 cm medial from the suprascapular notch Medial Scapular Body (section three). Goutallier grade, tangent sign, and modified Patte stage were used to evaluate fatty infiltration, muscle atrophy, and tendon retraction, respectively.
RESULTS: Section one had the highest Goutallier grade, while section three had the lowest. Intra-observer rest retest reliability analysis showed excellent consistency in all sections with section one (ICC=0.920, 95% CI), section two (ICC=0.917, 95% CI), and section three (ICC=0.923, 95% CI) for Goutallier grade. Inter-observer reliability analysis also revealed excellent consistency in sections one (ICC=0.951, 95% CI), section two (ICC=0.949, 95% CI), and section three (ICC=0.922, 95% CI) for Goutallier grade. A strong correlation was observed between Goutallier grade and modified Patte stage (τb=0.43-0.56, p=0.001), and between Goutallier grade and tangent sign (τb=0.43-0.54, p=0.001) across all sections.
CONCLUSIONS: The severity of fatty infiltration within the supraspinatus muscle belly is inconsistent, with the lateral portion being the most severe and the medial portion the least severe. Goutallier grade demonstrates a strong correlation with tangent sign and modified Patte stage. This suggests that tendon retraction results in a potential overestimation in the amount of fatty infiltration defining some tears unjustly irreparable when measuring at the traditionally described lateral Y-view position compared with 3cm medial.
摘要：
背景：手术修复脂肪浸润程度较高的肩袖撕裂是有争议的。目前的证据支持对表现为Goutallier3-4期脂肪浸润的患者进行肩袖修复。然而,撤回的存在使使用Goutallier分类的准确评估变得复杂，特别是在横向Y视图。向在更内侧区域中对脂肪浸润进行分类的转变可以增强组织质量量化的精度。这项研究的目的是使用Goutallier分类在三个肩胛骨Y视图切片中分析整个冈上肌脂肪浸润的均匀性，并检查Goutallier等级之间的关联。切线符号,并修改了Patte舞台。
方法：对之前接受过关节镜肩袖修复的97例患者的术前磁共振成像（MRI）扫描进行了回顾性评估。确定了MRI矢状面上的三个冈上肌切片：侧向Y视图（第1部分），肩胛骨上切迹解剖标志处的内侧部分（第二部分），和从肩胛骨上切迹内侧内侧3cm处（第三部分）。Goutallier等级,切线符号,和改良的Patte阶段用于评估脂肪浸润，肌肉萎缩,和肌腱收缩，分别。
结果：第一节的Goutallier评分最高，而第三节最低。观察者内部休息重测可靠性分析显示，所有部分与第一部分的一致性极佳(ICC=0.920，95%CI)，第二节(ICC=0.917，95%CI)，和第三节(ICC=0.923，95%CI)为Goutallier等级。观察者间可靠性分析在第一节中也显示出优异的一致性(ICC=0.951，95%CI)，第二节（ICC=0.949，95%CI），和第三节(ICC=0.922，95%CI)为Goutallier等级。在Goutallier等级和改良Patte阶段之间观察到了很强的相关性（τb=0.43-0.56，p=0.001），在所有部分的Goutallier等级和切线符号(τb=0.43-0.54，p=0.001)之间。
结论：冈上肌腹内脂肪浸润的严重程度不一致，外侧部分最严重，内侧部分最不严重。Goutallier等级与切线符号和修改的Patte阶段具有很强的相关性。这表明，与3cm内侧相比，在传统描述的外侧Y视图位置进行测量时，肌腱回缩会导致脂肪浸润量的潜在高估，从而定义了一些不可修复的眼泪。
方法：对之前接受过关节镜肩袖修复的97例患者的术前磁共振成像（MRI）扫描进行了回顾性评估。确定了MRI矢状面上的三个冈上肌切片：侧向Y视图（第1部分），肩胛骨上切迹解剖标志处的内侧部分（第二部分），和从肩胛骨上切迹内侧内侧3cm处（第三部分）。Goutallier等级,切线符号,和改良的Patte阶段用于评估脂肪浸润，肌肉萎缩,和肌腱收缩，分别。
结果：第一节的Goutallier评分最高，而第三节最低。观察者内部休息重测可靠性分析显示，所有部分与第一部分的一致性极佳(ICC=0.920，95%CI)，第二节(ICC=0.917，95%CI)，和第三节(ICC=0.923，95%CI)为Goutallier等级。观察者间可靠性分析在第一节中也显示出优异的一致性(ICC=0.951，95%CI)，第二节（ICC=0.949，95%CI），和第三节(ICC=0.922，95%CI)为Goutallier等级。在Goutallier等级和改良Patte阶段之间观察到了很强的相关性（τb=0.43-0.56，p=0.001），在所有部分的Goutallier等级和切线符号(τb=0.43-0.54，p=0.001)之间。
结论：冈上肌腹内脂肪浸润的严重程度不一致，外侧部分最严重，内侧部分最不严重。Goutallier等级与切线符号和修改的Patte阶段具有很强的相关性。这表明，与3cm内侧相比，在传统描述的外侧Y视图位置进行测量时，肌腱回缩会导致脂肪浸润量的潜在高估，从而定义了一些不可修复的眼泪。
