2025 ISAKOS Biennial Congress ePoster
MRI-Based Reliability and Validity of the Goutallier Classification for Grading Fatty Infiltration of the Rotator Cuff across the Whole Scapula
Ashish Gupta, MBBS, MSc, FRACS, FAORTHOA, Brisbane, QLD AUSTRALIA
Freek Hollman, MD, PhD, Venlo NETHERLANDS
Ruth Delaney, FRCS(Tr&Orth MMedSc (Sports Med), FFSEM, , Dublin IRELAND
Kenneth Cutbush, MBBS, FRACS, FAOrthA, Spring Hill, QLD AUSTRALIA
Quasr Collaborative, (QUASR), Brisbane, QLD AUSTRALIA
Queensland Unit for Advanced Shoulder Research (QUASR), Brisbane, QLD, AUSTRALIA
FDA Status Not Applicable
Summary
This study aims to propose the Medial Scapular Body-Goutallier Classification, which assesses the rotator cuff muscle bellies on multiple medial sagittal MRI sections beyond the Y view.
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Abstract
Introduction
Massive rotator cuff tears are associated with tendon retraction, resulting in a medialization of the muscle bulk. The degree of fatty infiltration of the cuff muscles is one of the key predictors for reparability of cuff tears. Traditionally, the Goutallier classification is assessed at the sagittal scapular Y-view, which could misrepresent cuff fatty infiltration in massive, retracted tears and may misguide clinicians when assessing repairability. This study aims to propose the Medial Scapular Body-Goutallier Classification, which assesses the rotator cuff muscle bellies on multiple medial sagittal MRI sections beyond the Y view. This study also aims to evaluate the reliability and repeatability of this proposed classification.
Methods
The fatty infiltration of the rotator cuff musculature was classified on MRIs based on the Goutallier grade (0 to 4) at three predefined sections: Section 1: original Y-view; Section 2: level of the suprascapular notch; and Section 3: three cm medial to the suprascapular notch. Six fellowship-trained shoulder surgeons and three musculoskeletal radiologists independently evaluated deidentified MRI scans of the included patients. Inter- and intraobserver reliabilities were determined.
Results
A total of 80 scans were included in the study. 78% were massive cuff tears involving supraspinatus, infraspinatus, and subscapularis tendons. Inter-observer reliability (consistency) for Goutallier grade was excellent for all three predefined sections (range:0.87–0.95). Intra-observer reliability (repeatability) for Goutallier grade was excellent for all sections and rotator cuff muscles (range:0.83-0.97). There was a moderate to strong positive correlation of Goutallier grades between Sections 1 and 3 and between Sections 2 and 3, and these were statistically significant (p<0.001). There was reduction in grading of Goutallier classification from Sections 1 to 3 across all muscles. 42.5% of both supraspinatus and infraspinatus were reduced in grade by one, 20% of supraspinatus and 3.8% of infraspinatus were reduced in grade by 2, and 2.5% of supraspinatus were reduced in grade by 3.
Conclusion
This study found that applying the Goutallier classification to more medial MRI sections resulted in the assignment of lower grades for all rotator cuff muscles. This proposed method showed excellent test-retest reliability and repeatability. Inclusion of the whole scapula on MRI, especially in advanced levels of tear retraction, may allow a more representative assessment of the degree of fatty infiltration within the muscle bulk that could help predict tear repairability and may possibly improve clinical decision-making.