Rotator cuff muscles fatty infiltration increases with age: retrospective review of 210 patients with intact cuff on computed tomography arthrography

Hypothesis: We aimed to demonstrate that rotator cuff fatty infiltration (FI) increases physiologically with age and that a FI degree of 2 might be encountered in patients with an intact cuff. Methods: We retrospectively evaluated the FI of 210 patients (classified in 7 age groups: <20, 20-30, 30-40, 40-50, 50-60, 60-70, and >70 years) who had an intact cuff on computed tomography (CT) arthrography. The Goutallier grading system was used to assess FI of rotator cuff muscles and of the deltoid muscle. FI was then compared between groups for each muscle, and determinants (age, sex, and body mass index) of FI were assessed. Results: FI of all evaluated muscles progressively increased with age, but a statistically significant increase between 2 consecutive age groups was observed for all muscles only after age 40 years. For each group, intermuscle comparison showed that the FI distribution was not significantly different between each rotator cuff muscle at any age. Age was a determinant for FI for all muscles, but sex and body mass index also influenced deltoid FI. A median FI value of 2 was found in the over 70 group for the supraspinatus, but in the 60 to 70 group for infraspinatus and subscapularis and in the 50 to 60 group for the deltoid. Conclusion: FI of rotator cuff muscles increased with age, with a significant acceleration after 40 years. Moreover, a FI graded 2, a common threshold for management decision, was commonly found in those aging patients with intact cuff on CT arthrography (C) 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.