Rotator cuff tears are common in the older population. Atrophy and fat infiltration develop un-evenly in torn supraspinatus (SSP) muscles leading to pre- and post-surgical complications. The purpose of the current study was twofold: first, to implement a volumetric and quantitative magnetic resonance imaging (MRI) approach to quantify the degree of muscle atrophy and fat infiltration within the SSP muscle and its four sub-regions (AS, PS, AD, and PD); second to compare 3-D MRI outcomes to the standard 2-D assessment and investigate their relationship with tear size.
Materials and methods
Fifteen cadaveric shoulders were obtained and MRI performed. Quantitative 3-D outcomes included SSP muscle volume, fossa volume, fat-free muscle volume, and fat fraction for the whole SSP muscle and its four sub-regions. 2-D and qualitative measurements included tear size, 2-D fat infiltration using the Goutallier classification, tangent sign, and occupation ratio.
Linear regression outcomes with tear size were not significant for both cross-sectional area (r = − 0.494, p = 0.061) and occupation ratio (r = − 0.011, p = 0.969). Tear size negatively correlated with fat-free muscle volume for both AS and PS sub-regions (AS: r = − 0.78, p < 0.001; PS: r = − 0.68, p = 0.005, respectively) while showing no significant correlation with fat fraction outcomes. AD and PD sub-regions positively correlated with tear size and fat fraction outcomes (AD: r = 0.70, p = 0.017; PD: r = 0.52, p = 0.045, respectively), while no significant correlation was observed between tear size and fat-free muscle volumes.
Quantitative 3-D volumetric assessment of muscle degeneration resulted in better outcomes compared to the standard 2-D evaluation. The superficial supraspinatus muscle sub-regions primarily presented muscle atrophy, while the deep sub-regions were mainly affected by fat infiltration. 3-D assessments could be used pre-surgically to determine the best course of treatment and to estimate the muscles’ regenerative capacity and function.
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This study was supported by the University of Texas at San Antonio. A co-author, Takuma Yuri, is funded by a Grant-in-Aid for JSPS fellows (Grant number 19J10699). We would like to thank Dr. Hiromi Fujii.
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The authors declare they have no conflicts of interest.
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Trevino III, J.H., Yuri, T., Hatta, T. et al. Three-dimensional quantitative measurements of atrophy and fat infiltration in sub-regions of the supraspinatus muscle show heterogeneous distributions: a cadaveric study. Arch Orthop Trauma Surg (2021). https://doi.org/10.1007/s00402-021-03765-8
- Rotator cuff tear
- Fat infiltration
- Goutallier classification
- Muscle sub-region
- Occupation ratio