Ayush Giri1, Thomas H Freeman2, Peter Kim3, John E Kuhn2, Gustavo A Garriga1, Michael Khazzam4, Laurence D Higgins5, Elizabeth Matzkin6, Keith M Baumgarten7, Julie Y Bishop8, Robert H Brophy9, James L Carey10, Warren R Dunn11, Grant L Jones8, C Benjamin Ma12, Robert G Marx13, Eric C McCarty14, Sourav K Poddar14, Matthew V Smith9, Edwin E Spencer15, Armando F Vidal16, Brian R Wolf17, Rick W Wright2, Nitin B Jain18. 1. Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA. 2. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Department of Orthopaedics, University of Texas Southwestern, Dallas, TX, USA. 5. King Edward Memorial Hospital, Hamilton, Bermuda. 6. Department of Orthopaedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 7. Orthopedic Institute of Sioux Falls, Sioux Falls, SD, USA. 8. Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, OH, USA. 9. Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA. 10. Department of Orthopaedic Surgery, University of Pennsylvania and Perelman School of Medicine, Philadelphia, PA, USA. 11. Department of Clinical Research, Fondren Orthopedic Group, Houston, TX, USA. 12. Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA. 13. Department of Orthopedic Surgery, Weill Medical College of Cornell University, New York, NY, USA. 14. Department of Orthopedic Sports Medicine, University of Colorado, Denver, CO, USA. 15. Shoulder & Elbow Division, Knoxville Orthopaedic Clinic, Knoxville, TN, USA. 16. The Steadman Clinic and Steadman Philippon Research Institute, Vial, CO, USA. 17. Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA. 18. Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Departments of Physical Medicine and Rehabilitation, Orthopaedics, and Population & Data Sciences, University of Texas Southwestern, Dallas, TX, USA. Electronic address: nitin.jain@utsouthwestern.edu.
Abstract
BACKGROUND: Fatty infiltration (FI) is one of the most important prognostic factors for outcomes after rotator cuff surgery. Established risk factors include advancing age, larger tear size, and increased tear chronicity. A growing body of evidence suggests that sex and obesity are associated with FI; however, data are limited. METHODS: We recruited 2 well-characterized multicenter cohorts of patients with rotator cuff tears (Multicenter Orthopaedic Outcomes Network [MOON] cohort [n = 80] and Rotator Cuff Outcomes Workgroup [ROW] cohort [n = 158]). We used multivariable logistic regression to evaluate the relationship between body mass index (BMI) and the presence of FI while adjusting for the participant's age at magnetic resonance imaging, sex, and duration of shoulder symptoms, as well as the cross-sectional area of the tear. We analyzed the 2 cohorts separately and performed a meta-analysis to combine estimates. RESULTS: A total of 27 patients (33.8%) in the Multicenter Orthopaedic Outcomes Network (MOON) cohort and 57 patients (36.1%) in the Rotator Cuff Outcomes Workgroup (ROW) cohort had FI. When BMI < 25 kg/m2 was used as the reference category, being overweight was associated with a 2.37-fold (95% confidence interval [CI], 0.77-7.29) increased odds of FI and being obese was associated with a 3.28-fold (95% CI, 1.16-9.25) increased odds of FI. Women were 4.9 times (95% CI, 2.06-11.69) as likely to have FI as men. CONCLUSIONS: Among patients with rotator cuff tears, obese patients had a substantially higher likelihood of FI. Further research is needed to assess whether modifying BMI can alter FI in patients with rotator cuff tears. This may have significant clinical implications for presurgical surgical management of rotator cuff tears. Sex was also significantly associated with FI, with women having higher odds of FI than men. Higher odds of FI in female patients may also explain previously reported early suboptimal outcomes of rotator cuff surgery and higher pain levels in female patients as compared with male patients.
BACKGROUND: Fatty infiltration (FI) is one of the most important prognostic factors for outcomes after rotator cuff surgery. Established risk factors include advancing age, larger tear size, and increased tear chronicity. A growing body of evidence suggests that sex and obesity are associated with FI; however, data are limited. METHODS: We recruited 2 well-characterized multicenter cohorts of patients with rotator cuff tears (Multicenter Orthopaedic Outcomes Network [MOON] cohort [n = 80] and Rotator Cuff Outcomes Workgroup [ROW] cohort [n = 158]). We used multivariable logistic regression to evaluate the relationship between body mass index (BMI) and the presence of FI while adjusting for the participant's age at magnetic resonance imaging, sex, and duration of shoulder symptoms, as well as the cross-sectional area of the tear. We analyzed the 2 cohorts separately and performed a meta-analysis to combine estimates. RESULTS: A total of 27 patients (33.8%) in the Multicenter Orthopaedic Outcomes Network (MOON) cohort and 57 patients (36.1%) in the Rotator Cuff Outcomes Workgroup (ROW) cohort had FI. When BMI < 25 kg/m2 was used as the reference category, being overweight was associated with a 2.37-fold (95% confidence interval [CI], 0.77-7.29) increased odds of FI and being obese was associated with a 3.28-fold (95% CI, 1.16-9.25) increased odds of FI. Women were 4.9 times (95% CI, 2.06-11.69) as likely to have FI as men. CONCLUSIONS: Among patients with rotator cuff tears, obese patients had a substantially higher likelihood of FI. Further research is needed to assess whether modifying BMI can alter FI in patients with rotator cuff tears. This may have significant clinical implications for presurgical surgical management of rotator cuff tears. Sex was also significantly associated with FI, with women having higher odds of FI than men. Higher odds of FI in female patients may also explain previously reported early suboptimal outcomes of rotator cuff surgery and higher pain levels in female patients as compared with male patients.
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Authors: Warren R Dunn; John E Kuhn; Rosemary Sanders; Qi An; Keith M Baumgarten; Julie Y Bishop; Robert H Brophy; James L Carey; G Brian Holloway; Grant L Jones; C Benjamin Ma; Robert G Marx; Eric C McCarty; Sourav K Poddar; Matthew V Smith; Edwin E Spencer; Armando F Vidal; Brian R Wolf; Rick W Wright Journal: J Bone Joint Surg Am Date: 2014-05-21 Impact factor: 5.284
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Authors: Stephen D Daniels; Cory M Stewart; Kirsten D Garvey; Emily M Brook; Laurence D Higgins; Elizabeth G Matzkin Journal: Orthop J Sports Med Date: 2019-11-25