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Comparison of the Goutallier Classification of Fatty Infiltration for the Subscapularis With a Novel Modified Classification

 Tae-Hwan Yoon  ;  Sung-Jae Kim  ;  Yun-Rak Choi  ;  Jung-Hyun Oh  ;  Yong-Min Chun 
 ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE, Vol.11(8) : 23259671231174428, 2023-08 
Journal Title
Issue Date
Goutallier classification ; fatty infiltration ; reliability ; repeated tear ; subscapularis
Background: Fatty infiltration in the subscapularis muscle extends to the upper portion of the muscle first and then to the lower portion only after some degree of fatty change has taken place in the upper region. Although the Goutallier classification is the most widely used method to categorize fatty infiltration, how to accurately and reliably determine the extent of infiltration is controversial.

Purpose: To examine a modified classification that is more reliable in (1) assessing fatty infiltration of the subscapularis muscle and (2) predicting the structural integrity of the repaired tendon by identifying cutoff points for retear.

Study design: Cohort study (diagnosis); Level of evidence, 3.

Methods: This study retrospectively examined the records of 545 patients who underwent arthroscopic repair for a subscapularis tear. Two shoulder surgeons reviewed the preoperative magnetic resonance imaging scans of all enrolled patients and evaluated the fatty infiltration of the subscapularis muscle based on the original Goutallier classification, as well as a novel modified Goutallier classification designed to measure the proportion of fat and muscle in the upper and lower portions of the muscle separately. Intra- and interobserver agreement of the reviewers was calculated using κ statistics. Using receiver operating characteristic curve analysis, we determined the cutoff point for the particular fatty infiltration grade related to the occurrence of retear for each classification scheme.

Results: The κ values for interobserver reliability were 0.743 and 0.856 for the original and modified Goutallier classifications, respectively, with the modified classification having significantly higher reliability (Z = 4.064; P < .001). Cutoff points for the fatty infiltration grade associated with retear were 2.5 for the original Goutallier classification (sensitivity, 65.3%; specificity, 95.6%; accuracy, 87.8%) and 3.5 for the modified classification (sensitivity, 52.5%; specificity, 97.8%; accuracy, 89.7%).

Conclusion: In assessing fatty infiltration of the subscapularis muscle, the modified Goutallier classification showed higher reliability than the original Goutallier classification. The cutoff point for potential retear (grade 3.5) was at a point where the fatty infiltration extended to the lower portion of the subscapularis muscle.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sung Jae(김성재)
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
Choi, Yun Rak(최윤락)
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