Relationship Between BMI and Preoperative Fat Infiltration Grading on Postoperative Recovery of Rotator Cuff Function

Guan Jiekai; Hu Huayue; Zhang Zhiyang; Wang Yujie; Wang Dongliang; He Jiye

doi:10.3969/j.issn.1008-5572.2026.01.007

Abstract：Objective To investigate the relationship between body mass index(BMI)and preoperative rotator cuff muscle fat infiltration grading(Goutallier classification)on functional recovery after arthroscopic rotator cuff repair,aiming to evaluate the potential role of fat infiltration.Methods A retrospective cohort study included 143 patients[48 males and 95 females;aged 50 to 84 years,mean age(62.88±7.67)years]who underwent arthroscopic rotator cuff repair treated at Xinhua hospital affiliated to Shanghai Jiao Tong university school of medicine and completed follow-up between January 2023 and June 2024.BMI was categorized into underweight,normal,and overweight groups[underweight＜18.5 kg/m2(34 patients),normal BMI=18.5～24.9 kg/m2(41 patients),high BMI≥25.0 kg/m2(68 patients)].Data collected included BMI,preoperative MRI Goutallier grade of supraspinatus fat infiltration,preoperative and postoperative range of motion(ROM),visual analogue scale(VAS)for pain,and American shoulder and elbow surgeons(ASES)score.Spearman correlation analysis assessed the relationship between BMI and fat infiltration.A regression model using 12-month postoperative ROM as the primary endpoint analyzed the independent association between BMI and functional recovery.Results All patients were followed up for at least 12 months.BMI positively correlated with preoperative supraspinatus fat infiltration grade(P＜0.05),with a significantly higher proportion of moderate-to-severe infiltration in the higher BMI group.Follow-up at 1 and 12 months postoperatively revealed significant differences in 1 2-month ROM,VAS and ASES between the high BMI group and the other two groups,with a linear decline trend as BMI grade increased(P＜0.01).The proportion of Goutallier grade≥2 also showed an increasing distribution with rising BMI.Multivariate regression analysis revealed that BMI was an independent adverse predictor of 12-month ROM(P＜0.001),while fat infiltration grade had no significant independent effect on ROM(P＞0.05).Conclusion Increased rotator cuff muscle fat infiltration is closely associated with elevated BMI,and BMI serves as an independent predictor of poor functional recovery after rotator cuff repair.Preoperative emphasis should be placed on imaging evaluation and prognostic communication for patients with high BMI,complemented by individualized management strategies during the perioperative and rehabilitation phases to optimize postoperative recovery outcomes.