Fatty infiltration (FI) is an important prognosis factor in the anatomical and functional outcomes of rotator cuff repairs. The objective of this study was to analyze the natural history of muscle FI and better evaluate its onset and aggravation time frame.

A total of 1688 medical charts of patients operated on for rotator cuff tear and whit a preoperative CT arthrogram (82%) or an MRI (18%) were reviewed. Surgery was performed between 1988 and 2005. The FI of each muscle was assessed as minimal (in Goutallier’s stages 0 and 1), intermediate (in stage 2), and severe (in stages 3 and 4). Regarding supraspinatus, we retained the mean FI observed in the sagittal, coronal, and axial planes; for the infraspinatus and the subscapularis, we retained the observed mean on two views at the upper and lower levels of the glenoid in the axial plane.

We found a statistically significant correlation (p<0.0005) between FI, the type of tendon lesion, and patient age for the supraspinatus, the infraspinatus, and the subscapularis. Statistically, the FI significantly increased (p<0.0005) with time elapsed for the supraspinatus and the infraspinatus but not significantly for the subscapularis. The mean time to tendon rupture observed for intermediate FI was three years for the supraspinatus and 2.5 years for the infraspinatus and the subscapularis when their tendons ruptured. The mean time observed to severe FI was five, four, and three years for the supraspinatus, the infraspinatus, and the subscapularis, respectively.

The more extensive the lesion, the longer the time following rupture, and the older the patient is, the more severe the FI is. The objective of surgery is to intervene before intermediate FI sets in, which means irreversible functional loss.

Level of evidence: Level IV. Diagnostic Retrospective Study.