ArticleBMC musculoskeletal disorders2026
Does fat infiltration of the rotator cuff muscles contribute to increased hidden blood loss (HBL) and other risk factors during arthroscopic rotator cuff repair for rotator cuff injuries?
Article in BMC musculoskeletal disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study aimed to compare hidden blood loss (HBL) in patients undergoing arthroscopic rotator cuff repair based on the degree of rotator cuff fatty infiltration, and to determine whether fatty infiltration is associated with increased HBL and other risk factors.
methodsA retrospective analysis included 141 patients undergoing arthroscopic rotator cuff repair between January 2023 and March 2025. Patients were grouped by rotator cuff fatty infiltration severity (Grades 0-4). Demographics and blood parameters were recorded. Visible blood loss was quantified, and hidden blood loss (HBL) was calculated using preoperative hematocrit (Hctpre) and postoperative hematocrit (Hctpost) to assess total blood loss. Relationships with HBL were analyzed using Pearson/Spearman correlation, Mann-Whitney U test, and multivariate linear regression to identify independent risk factors.
resultsMultivariate linear regression analysis identified the following independent risk factors for HBL: Hctpost (β = -482.318. 95% CI: -814.825to -149.811, p = 0.005), intraoperative blood loss (β = 0.679, 95% CI: 0.444 to ,0.915, P < 0.001), the classification of fatty infiltration (β = 28.279, 95% CI: 13.774to 42.783, P < 0.001), and the grading of tear size (β = 20.954, 95% CI: 3.580 to 38.329, p = 0.018). Notably, the HBL increased significantly with the classification of fatty infiltration(P < 0.001), with median (IQR) values as follows: Stage 0: 293.65(234.20-331.08) ml, Stage 1: 339.66(264.78-376.54) ml, Stage 2: 355.21(268.05-450.66) ml, Stage 3:462.92(340.57-517.23) ml, and Stage 4: 512.23(431.12-575.98)ml.
conclusionPatients exhibiting higher classification of fatty infiltration in the rotator cuff muscles, as well as those with more extensive rotator cuff tears, may be associated with increased levels of hidden blood loss (HBL) during arthroscopic rotator cuff repair. Factors such as Hctpost, intraoperative bleeding volume, severity of fatty infiltration, and tear size have been suggested as potential independent risk factors for HBL. Close perioperative monitoring of these parameters could contribute to improved patient safety during arthroscopic rotator cuff repair procedures.
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