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Levin JM, Johnson J, Tabarestani T, Rueckert H, Leinroth A, Ruderman L, Klifto CS, Hilton MJ, Anakwenze O. Association Between Supraspinatus Tendon Retraction, Histologic Myofiber Size, and Supraspinatus Muscle Atrophy on MRI. Am J Sports Med 2023; 51:1997-2004. [PMID: 37260272 PMCID: PMC10964200 DOI: 10.1177/03635465231173697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Atrophy of the rotator cuff is a negative prognostic indicator after rotator cuff repair. Although full-thickness rotator cuff tears accompanied by tendon retraction are commonly associated with decreased muscle cross-sectional area (CSA) on magnetic resonance imaging (MRI), it is unclear whether this is accompanied by histologic atrophy of rotator cuff myofibers. PURPOSE To evaluate the effect of supraspinatus tendon retraction and myofiber size on supraspinatus atrophy on MRI. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Supraspinatus muscle biopsy specimens were obtained from consecutive patients undergoing arthroscopic shoulder surgery. Rotator cuff tears were classified according to size. Preoperative MRI was used to measure tendon retraction and CSA of the supraspinatus muscle in the Y-shaped view. The occupation ratio of the supraspinatus was calculated by dividing the supraspinatus CSA by the supraspinatus fossa CSA. Muscle biopsy specimens were examined using laminin to quantify myofiber CSA. The association between supraspinatus tear size and measures of histologic and MRI muscle atrophy were compared using standard statistical tests. Multivariable logistic regression analysis was used to identify independent predictors of muscle atrophy on MRI. RESULTS A total of 38 patients were included: 8 with no tear, 14 with a partial-thickness tear, and 16 with a full-thickness tear. Increasing tear size was associated with greater distance of tendon retraction (P < .001), smaller mean histologic myofiber size (P = .004), lower mean supraspinatus CSA on MRI (P < .001), and lower occupation ratio: 0.73 (control), 0.66 (partial tear), 0.53 (small to medium full-thickness tear), and 0.38 (large to massive full-thickness) (P < .001). On Pearson correlation analysis, tendon retraction demonstrated strong correlation with occupation ratio (-0.725; P < .001) and weak correlation with myofiber size (-0.437; P = .006), while occupation ratio showed moderate correlation with myofiber size (0.593; P < .001). Multivariable linear regression analysis demonstrated that increasing tendon retraction (P < .001), age (P = .034), and smaller histologic myofiber CSA (P = .047) were independently associated with greater supraspinatus atrophy on MRI. CONCLUSION Supraspinatus muscle atrophy appreciated on MRI is independently associated with patient age, tendon retraction, and atrophy of the supraspinatus myofibers at the histologic level.
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Affiliation(s)
- Jay M Levin
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Jeremiah Johnson
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Troy Tabarestani
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Helen Rueckert
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Cell Biology, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Abigail Leinroth
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Cell Biology, School of Medicine, Duke University, Durham, North Carolina, USA
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Lindsey Ruderman
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Matthew J Hilton
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
- Department of Cell Biology, School of Medicine, Duke University, Durham, North Carolina, USA
| | - Oke Anakwenze
- Department of Orthopaedic Surgery, School of Medicine, Duke University, Durham, North Carolina, USA
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Tabarestani T, Sykes D, Murphy KR, Wang TY, Shaffrey CI, Goodwin CR, Horne P, Than KD, Abd-El-Barr MM. 490 Beyond Placement of Pedicle Screws - New Applications for Robotics in Spine Surgery: A Multi-Surgeon, Single-Institution Experience. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Sykes D, Tabarestani T, Chaudhry NS, Berger M, Ayoub C, Gadsden J, Gupta DK, Shaffrey CI, Abd-El-Barr MM. 361 Awake Spinal Fusion Leads to Decreased Postoperative Opioid Use and Decreased Length of Stay Compared to General Anesthesia: A Matched Cohort Study. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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Sykes D, Tabarestani T, Chaudhry NS, Berger M, Ayoub C, Gadsden J, Gupta DK, Shaffrey CI, Abd-El-Barr MM. 365 Awake Spine Surgery for Traditionally Poor Surgical Candidates: An Illustrative Cohort. Neurosurgery 2023; 69:62-62. [DOI: 10.1227/neu.0000000000002375_365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
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Ruderman L, Leinroth A, Rueckert H, Tabarestani T, Baker R, Levin J, Cook CE, Klifto CS, Hilton MJ, Anakwenze O. Histologic Differences in Human Rotator Cuff Muscle Based on Tear Characteristics. J Bone Joint Surg Am 2022; 104:1148-1156. [PMID: 35776739 PMCID: PMC10771098 DOI: 10.2106/jbjs.21.01304] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatty accumulation in the rotator cuff is associated with shoulder dysfunction and a risk of failure of rotator cuff repair. The aims of this study were to (1) describe cellular findings in rotator cuff muscles in patients presenting with varying degrees of rotator cuff tendon pathology by examining fat content and myofiber cross-sectional area of rotator cuff muscles and (2) correlate histologic features to magnetic resonance imaging (MRI) grades derived with the Goutallier classification. METHODS Rotator cuff muscle biopsies were performed in a consecutive series of patients undergoing arthroscopic shoulder surgery. Rotator cuffs were graded according to the Goutallier classification and labeled as either partial-thickness or full-thickness. Patients without a rotator cuff tear undergoing arthroscopic surgery served as controls. The biopsy specimens were examined using LipidTOX to visualize lipid accumulation. Laminin was used to quantify myofiber cross-sectional area. RESULTS Twenty-seven patients with a rotator cuff tear and 12 without a tear (controls) were included. There were 24 males (62%). The mean age was 55 years. Patients in the control cohort were younger (mean, 46 years) than those in the treatment group (mean, 60 years, p < 0.01). Within the treatment group, 12 and 15 patients were recorded as having partial and full-thickness rotator cuff tears, respectively. Lipid accumulation visualized at the cellular level was fairly-to-moderately correlated with the Goutallier classification on MRI (R s = 0.705, 95% confidence interval [CI] = 0.513, 0.829). Muscle biopsy specimens with a Goutallier grade of 2+ had significantly more lipid accumulation than those with grade-0 (p < 0.01) or grade-1 (p < 0.01) fatty accumulation. Muscle biopsies at the sites of full-thickness tears showed significantly greater lipid accumulation than those associated with either partial (p < 0.01) or no (p < 0.01) tears. Partial-thickness rotator cuff tears had no difference in lipid accumulation in comparison to the control group. Muscle biopsy specimens from full-thickness tears had significantly smaller myofiber cross-sectional area when compared with partial-thickness tears (p = 0.02) and controls (p < 0.01). CONCLUSIONS Cellular lipid accumulation correlates with the MRI Goutallier grade of fatty accumulation, thus verifying the Goutallier classification at the cellular level. Muscle biopsy specimens from partial-thickness tears are more similar to controls than to those from full-thickness tears, whereas full-thickness tears of all sizes showed significantly greater lipid content and smaller myofiber cross-sectional area compared with partial-thickness tears and controls. CLINICAL RELEVANCE Our research confirms the utility of using the Goutallier classification to predict rotator cuff muscle quality and shows that tendon attachment, even if partially torn, protects the muscle from fatty accumulation.
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Affiliation(s)
- Lindsey Ruderman
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
| | - Abigail Leinroth
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
- Department of Cell Biology, Duke University, Durham, NC
| | - Helen Rueckert
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
- Department of Cell Biology, Duke University, Durham, NC
| | - Troy Tabarestani
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
| | - Rafeal Baker
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
| | - Jay Levin
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
| | - Chad E. Cook
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
| | - Matthew J. Hilton
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
- Department of Cell Biology, Duke University, Durham, NC
| | - Oke Anakwenze
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC
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