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Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear.
Am J Sports Med. 2017 Sep; 45(11):2555-2562.AJ

Abstract

BACKGROUND

The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears.

PURPOSE

To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively.

RESULTS

We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) (P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation (P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery.

CONCLUSION

Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.

Authors+Show Affiliations

Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea.Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea.Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea.Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28787191

Citation

Lee, Sung Hyun, et al. "Comparison of Clinical and Structural Outcomes By Subscapularis Tendon Status in Massive Rotator Cuff Tear." The American Journal of Sports Medicine, vol. 45, no. 11, 2017, pp. 2555-2562.
Lee SH, Nam DJ, Kim SJ, et al. Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear. Am J Sports Med. 2017;45(11):2555-2562.
Lee, S. H., Nam, D. J., Kim, S. J., & Kim, J. W. (2017). Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear. The American Journal of Sports Medicine, 45(11), 2555-2562. https://doi.org/10.1177/0363546517721187
Lee SH, et al. Comparison of Clinical and Structural Outcomes By Subscapularis Tendon Status in Massive Rotator Cuff Tear. Am J Sports Med. 2017;45(11):2555-2562. PubMed PMID: 28787191.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear. AU - Lee,Sung Hyun, AU - Nam,Dae Jin, AU - Kim,Se Jin, AU - Kim,Jeong Woo, Y1 - 2017/08/08/ PY - 2017/8/9/pubmed PY - 2018/2/9/medline PY - 2017/8/9/entrez KW - fatty degeneration KW - functional and structural outcomes KW - massive rotator cuff tear KW - rotator cuff KW - subscapularis tear KW - tendon integrity SP - 2555 EP - 2562 JF - The American journal of sports medicine JO - Am J Sports Med VL - 45 IS - 11 N2 - BACKGROUND: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. PURPOSE: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. RESULTS: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) (P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation (P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. CONCLUSION: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/28787191/Comparison_of_Clinical_and_Structural_Outcomes_by_Subscapularis_Tendon_Status_in_Massive_Rotator_Cuff_Tear_ L2 - http://journals.sagepub.com/doi/full/10.1177/0363546517721187?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -