Does subscapularis tears combined with supraspinatus tears affect postoperative functional outcomes?
Abstract
Aims: Roughly 50% of rotator cuff tears includes a tear in the subscapularis tendon. We conducted a comparative analysis of the functional outcomes following arthroscopic repair in patients with a tear in both the supraspinatus and subscapularis tendons, as well as those with a rupture solely in the supraspinatus tendon. Our hypothesis posits that the functional outcomes after surgery for rotator cuff tears, specifically those with tears including subscapularis tendon, are inferior compared to tears that only involve the supraspinatus tendon.
Methods: We classified patients who had arthroscopic repair for a rotator cuff tear in our clinic from January 2017 to April 2022 into two groups. The study comprised patients who received arthroscopic surgery for a diagnosed rotator cuff injury. The study excluded individuals who were younger than 18, individuals with large tears that could not be repaired, individuals with paralabral cysts, individuals with glenohumeral arthritis, individuals who had undergone labrum tear repair or slap lesion repair, individuals with concomitant neurovascular damage, and individuals who had a follow-up period of less than 6 months, patients who benefit from physiotherapy and medical treatment for 6 months. Following the application of exclusion criteria, a total of 39 patients were selected to participate in the study. The presence of a rotator cuff injury was verified through arthroscopy after being detected using clinical tests such as Jobe, drop arm test, Neer sign, lift-off and belly-press tests, and radiographic evidence such as magnetic resonance imaging. Patients who received subscapularis repair together with a supraspinatus tear were categorised as Group 1 (n=14), while those who just had supraspinatus surgery without any subscapularis tears were categorized as Group 2 (n=25). We recorded the demographic information. At the last postoperative outpatient clinic follow-up, both groups were compared in terms of mortality, laboratory parameters, radiological findings, visual analogue scale (VAS), Constant-Murley score1, American Shoulder and Elbow Surgeons score (ASES)2, and University of California Los Angeles (UCLA) scores.3 Postoperative satisfaction levels were categorised into four groups: very satisfied, satisfied, undecided, and dissatisfied.
Results: The groups did not show any significant differences in terms of age, gender distribution, and follow-up periods (p>0.05). There was no statistically significant disparity observed between the groups in relation to VAS, Constant-Murley score, ASES, and UCLA ratings assessed during the final postoperative outpatient clinic follow-up (p>0.05). There were no instances of re-rupture observed in any patient throughout the postoperative follow-up period. The postoperative satisfaction ratings show no significant difference between the two groups (p>0.05).
Conclusion: Our findings indicate that the outcomes of patients who received a surgical repair of rotator cuff tendons including subscapularis were at least as successful as those who underwent surgery for just supraspinatus tendon rupture. There is no basis to believe that arthroscopic repair will have a detrimental impact on the functional outcomes of individuals with rotator cuff tears which includes subscapularis tendon tears.
References
- Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-164.
- Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-594. doi:10.1067/mse.2002. 127096
- Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. end-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-1144.
- Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116-120. doi:10.1016/j.jse.2009.04.006
- Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am. 2012;94(3):227-233. doi:10.2106/JBJS.J.00739
- Agout C, Berhouet J, Bouju Y, et al. Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2490-2497. doi:10.1007/s00167-018-4854-1
- Malavolta EA, Chang VYP, Montechi JMN, et al. Does a subscapularis tear combined with a posterosuperior rotator cuff tear affect postoperative functional outcomes? J Shoulder Elbow Surg. 2020;29(12):2523-2529. doi:10.1016/j.jse.2020.03.044
- Richards DP, Burkhart SS, Lo IK. Subscapularis tears: arthroscopic repair techniques. Orthop Clin North Am. 2003;34(4):485-498. doi:10.1016/s0030-5898(03)00096-8
- Park JY, Chung SW, Lee SJ, et al. Combined subscapularis tears in massive posterosuperior rotator cuff tears: do they affect postoperative shoulder function and rotator cuff integrity? Am J Sports Med. 2016;44(1):183-190. doi:10.1177/0363546515610552
- Yoo JC, McGarry MH, Jun BJ, Scott J, Lee TQ. The influence of partial subscapularis tendon tears combined with supraspinatus tendon tears. J Shoulder Elbow Surg. 2014;23(6):902-908. doi: 10.1016/j.jse.2013.09.015
- Garavaglia G, Ufenast H, Taverna E. The frequency of subscapularis tears in arthroscopic rotator cuff repairs: a retrospective study comparing magnetic resonance imaging and arthroscopic findings. Int J Shoulder Surg. 2011;5(4):90-94. doi:10.4103/0973-6042.91000
- Gyftopoulos S, O'Donnell J, Shah NP, Goss J, Babb J, Recht MP. Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division's experience. Skeletal Radiol. 2013;42(9):1269-1275. doi:10.1007/s00256-013-1669-5
- Furukawa R, Morihara T, Arai Y, et al. Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images. J Shoulder Elbow Surg. 2014;23(11):e283-e290. doi:10.1016/j.jse.2014.03.011
- Malavolta EA, Assuncao JH, Guglielmetti CL, et al. Accuracy of preoperative MRI in the diagnosis of subscapularis tears. Arch Orthop Trauma Surg. 2016;136(10):1425-1430. doi:10.1007/s00402-016-2507-8
- Lafosse L, Lanz U, Saintmard B, Campens C. Arthroscopic repair of subscapularis tear: surgical technique and results. Orthop Traumatol Surg Res. 2010;96(8):S99-S108. doi:10.1016/j.otsr.2010.09.009
- Park MC, Elattrache NS, Ahmad CS, Tibone JE. "Transosseous-equivalent" rotator cuff repair technique. Arthroscopy. 2006;22(12):1360.e1-1360.e5. doi:10.1016/j.arthro.2006.07.017
- Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox III RB. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016;25(4):521-535. doi:10.1016/j.jse.2015.12.018
- Yoon TH, Kim SJ, Choi YR, Shin JC, Alruwaili SH, Chun YM. Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement. Knee Surg Sports Traumatol Arthrosc. 2021;29(1):154-161. doi:10.1007/s00167-020-05891-z
- Longo UG, Carnevale A, Piergentili I, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021;22(1):749. doi:10.1186/s12891-021-04634-6
- Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am. 2007;89(11):2378-2388. doi:10.2106/JBJS.G.00082
Supraspinatus rüptürlerine eşlik eden subscapularis yırtıkları postoperatif fonksiyonel sonuçları etkiler mi?
Abstract
Amaç: Rotator manşet yırtıklarının yaklaşık yarısında subscapularis tendon yırtığının eşlik ettiği bildirilmiştir. Subscapularis tendon yırtığının eşlik ettiği supraspinatus yırtığı olan hastalarda artroskopik tamir sonrası fonksiyonel sonuçları, izole supraspinatus tendon yırtığı olan hastaların artroskopik tamir sonrası fonksiyonel sonuçları ile karşılaştırarak “Rotator kablonun etkilendiği subscupalaris tendon yırtığı eşlik eden rotator manşet yırtıklarında ameliyat sonrası fonksiyonel sonuçlar izole supraspinatus tendon yırtıklarına göre daha kötüdür.” hipotezinin doğruluğunu araştırmayı amaçladık.
Materyal ve metod: Kliniğimizde Ocak 2017 ile Nisan 2022 tarihleri arasında rotator manşet yırtığı nedeniyle artroskopik tamir uygulanan hastalardan subscapularis tendon yırtığının eşlik ettiği supraspinatus yırtığı olguları Grup 1, subscapularis tendonun sağlam olduğu yalnızca supraspinatus tendon tamiri uygulanan hastalar Grup 2 olarak sınıflandırıldı. Her iki grup; mortalite, laboratuvar parametreleri, radyolojik bulgular, ameliyat sonrası son poliklinik kontrollerinde görsel analog skala (VAS), Constant-Murley skoru, American Shoulder and Elbow Surgeons skoru (ASES), University of California Los Angeles (UCLA) skorları açısından karşılaştırıldı. Ameliyat sonrası memnuniyet düzeyleri; çok memnun, memnun, kararsız ve memnun değil olmak üzere 4 kategoride sınıflandırıldı.
Bulgular: Gruplar arasında yaş, cinsiyet dağılımı ve takip süreleri açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Ameliyat sonrası son poliklinik kontrollerinde değerlendirilen VAS, Constant-Murley skoru, ASES ve UCLA skorları açısından gruplar arasında anlamlı fark yoktu (p>0.05). Ameliyat sonrası takip süresi boyunca hiçbir hastada rerüptür gözlenmedi. Ameliyat sonrası memnuniyet düzeyleri her iki grupta istatiksel olarak benzerdi (p>0.05).
Sonuç: Biz, subscapularis tendon tamiri yapılan hastalarda sonuçların en az izole supraspinatus tendon tamiri yapılan hastalar kadar başarılı olduğu sonucuna ulaştık. Subscapularis tendon yırtığı eşlik eden rotator manşet yırtığı olan hastalarda artroskopik tamirin fonksiyonel sonuçları kötü etkileyeceği düşüncesinin yersizdir.
References
- Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160-164.
- Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-594. doi:10.1067/mse.2002. 127096
- Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. end-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-1144.
- Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116-120. doi:10.1016/j.jse.2009.04.006
- Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am. 2012;94(3):227-233. doi:10.2106/JBJS.J.00739
- Agout C, Berhouet J, Bouju Y, et al. Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc. 2018;26(8):2490-2497. doi:10.1007/s00167-018-4854-1
- Malavolta EA, Chang VYP, Montechi JMN, et al. Does a subscapularis tear combined with a posterosuperior rotator cuff tear affect postoperative functional outcomes? J Shoulder Elbow Surg. 2020;29(12):2523-2529. doi:10.1016/j.jse.2020.03.044
- Richards DP, Burkhart SS, Lo IK. Subscapularis tears: arthroscopic repair techniques. Orthop Clin North Am. 2003;34(4):485-498. doi:10.1016/s0030-5898(03)00096-8
- Park JY, Chung SW, Lee SJ, et al. Combined subscapularis tears in massive posterosuperior rotator cuff tears: do they affect postoperative shoulder function and rotator cuff integrity? Am J Sports Med. 2016;44(1):183-190. doi:10.1177/0363546515610552
- Yoo JC, McGarry MH, Jun BJ, Scott J, Lee TQ. The influence of partial subscapularis tendon tears combined with supraspinatus tendon tears. J Shoulder Elbow Surg. 2014;23(6):902-908. doi: 10.1016/j.jse.2013.09.015
- Garavaglia G, Ufenast H, Taverna E. The frequency of subscapularis tears in arthroscopic rotator cuff repairs: a retrospective study comparing magnetic resonance imaging and arthroscopic findings. Int J Shoulder Surg. 2011;5(4):90-94. doi:10.4103/0973-6042.91000
- Gyftopoulos S, O'Donnell J, Shah NP, Goss J, Babb J, Recht MP. Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division's experience. Skeletal Radiol. 2013;42(9):1269-1275. doi:10.1007/s00256-013-1669-5
- Furukawa R, Morihara T, Arai Y, et al. Diagnostic accuracy of magnetic resonance imaging for subscapularis tendon tears using radial-slice magnetic resonance images. J Shoulder Elbow Surg. 2014;23(11):e283-e290. doi:10.1016/j.jse.2014.03.011
- Malavolta EA, Assuncao JH, Guglielmetti CL, et al. Accuracy of preoperative MRI in the diagnosis of subscapularis tears. Arch Orthop Trauma Surg. 2016;136(10):1425-1430. doi:10.1007/s00402-016-2507-8
- Lafosse L, Lanz U, Saintmard B, Campens C. Arthroscopic repair of subscapularis tear: surgical technique and results. Orthop Traumatol Surg Res. 2010;96(8):S99-S108. doi:10.1016/j.otsr.2010.09.009
- Park MC, Elattrache NS, Ahmad CS, Tibone JE. "Transosseous-equivalent" rotator cuff repair technique. Arthroscopy. 2006;22(12):1360.e1-1360.e5. doi:10.1016/j.arthro.2006.07.017
- Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox III RB. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016;25(4):521-535. doi:10.1016/j.jse.2015.12.018
- Yoon TH, Kim SJ, Choi YR, Shin JC, Alruwaili SH, Chun YM. Anterior rotator cable disruption does not affect outcomes in rotator cuff tear with subscapularis involvement. Knee Surg Sports Traumatol Arthrosc. 2021;29(1):154-161. doi:10.1007/s00167-020-05891-z
- Longo UG, Carnevale A, Piergentili I, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021;22(1):749. doi:10.1186/s12891-021-04634-6
- Ide J, Tokiyoshi A, Hirose J, Mizuta H. Arthroscopic repair of traumatic combined rotator cuff tears involving the subscapularis tendon. J Bone Joint Surg Am. 2007;89(11):2378-2388. doi:10.2106/JBJS.G.00082
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| Primary Language | English |
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| Subjects | Orthopaedics |
| Journal Section | Original Article |
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| Early Pub Date | January 15, 2024 |
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