Review Question - QID 213909

The Goutallier classification is used to quantify the amount of fatty degeneration of the rotator cuff musculature, particularly in the context of rotator cuff tears. The patient in this vignette has an MRI demonstrating Goutallier grade 4 rotator cuff degeneration, entailing more fat than muscle and conveying the greatest risk for retear of the above risk factors.

The Goutallier classification aids in the determination of rotator cuff quality. A greater degree of fatty degeneration of the muscle belly has been demonstrated to increase the risk of retear. Other variables which have been found to increase risk of retear include age >65 years, size of the tear (>5cm), multiple tendon involvement, diabetes, smoking, tendon retraction medial to the glenoid, poor post-operative compliance, and concomitant acromioclavicular and/or biceps procedures performed at the time of repair.

Cho et al. reviewed the clinical results and repair integrity after arthroscopic rotator cuff repair using a suture bridge technique. The authors reported complete healing in 66.7% of shoulders with a recurrent tear rate of 33.3%. They found that greater preoperative fatty degeneration of the cuff muscles was associated with a higher risk of recurrent tear. The authors concluded that the factors impairing tendon healing were increasing patient's age, tear size, and extent of the tear, as well as the presence of fatty degeneration of the cuff.

Lee et al. retrospectively reviewed the preoperative and intraoperative risk factors for retear following rotator cuff repair. The authors reported a retear rate of 7.22%. They concluded that the patient’s age, initial tear size, and fatty degeneration of the supraspinatus were independent risk factors for rotator cuff retear, whereas the completeness of rotator cuff repair based on the extent of footprint coverage and repair technique were not.

Figure A demonstrates a significant fatty degeneration of the supraspinatus muscle. There is more fat than muscle which classifies this as a Goutallier 4.
Figure B is an intraoperative image demonstrating arthroscopic repair of the supraspinatus utilizing a double-row repair technique.
Illustration A demonstrates the Goutallier classification.

Incorrect Answers:
Answer 1: Age >65 years is a risk factor for retear.
Answer 3: Delayed motion rehabilitation protocols have been shown to have comparable if not a reduced risk of retear as compared to early motion rehabilitation protocols following rotator cuff repair.
Answer 4: Technique, such as the double row suture bridge repair performed in this case, has not been shown to be a risk factor for retear.
Answer 5: Female gender is not a risk factor for retear following rotator cuff repair.