Arthroscopic Repair of Isolated Subscapularis Tears: A Systematic Review of Technique-Specific Outcomes

Saltzman, Bryan M.; Collins, Michael J.; Leroux, Timothy; Arns, Thomas A.; Griffin, Justin W.; Romeo, Anthony A.; Verma, Nikhil N.; Forsythe, Brian

doi:10.1016/j.arthro.2016.10.020

Cited by 54 publications

(52 citation statements)

References 30 publications

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“…21 Nonetheless, future prospective, comparative studies are needed to determine whether single-or double-row fixation provides better clinical and radiological outcomes after SSC RCT repair. 52 Regarding postoperative physical management, all of the patients in the current study were immobilized for 4 to 6 weeks with restriction of passive ROM, similar to previous reports that focused on tears that involved the SSC. 1,50 However, authors of some previous studies allowed passive mobilization during the first 6 weeks while active movements were restricted.…”

Section: Discussionsupporting

confidence: 54%

“…4,31,44 Moreover, because of the close proximity of the muscles in the rotator cuff, it is difficult to differentially diagnose isolated SSC and combined SSC RCTs; therefore, there is a need to evaluate the differences in their clinical and radiological characteristics as well as treatment outcomes. 15,17,29,43 Notably, many previous studies have reported an improvement in SSC function after both open and arthroscopic repair compared with the preoperative status in isolated SSC 3,6,22,27,39,41,45,52 and combined AS RCTs. 5,12,23 Furthermore, studies comparing the clinical outcomes in isolated SSC and combined AS RCTs have shown similar results after open repair.…”

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confidence: 99%

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Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Meshram

Rhee

Park

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Few studies have compared the clinical and radiological characteristics and outcomes in isolated subscapularis (SSC) and combined anterosuperior (AS) rotator cuff tears (RCTs). Furthermore, risk factors for retear after SSC repair and the effect of preoperative fatty degeneration require further evaluation.Purpose: To compare the functional and radiological outcomes of isolated SSC with combined AS RCTs after arthroscopic repair and to determine the risk factors for SSC retear in these 2 groups.Study Design: Cohort study; Level of evidence, 3.Methods: Data from 30 patients in the isolated SSC group were compared with data from 110 patients in the combined AS group. All patients underwent primary arthroscopic rotator cuff repair between 2010 and 2016. Clinical outcomes were assessed through use of the visual analog scale for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test at a mean followup of 26.7 months (range, 24-96 months). SSC tendon integrity was examined via magnetic resonance imaging, computed tomography arthrogram, or ultrasonography at least 1 year after surgery.Results: The isolated SSC group had a greater proportion of males and the patients were younger compared with the combined AS group (both P < .050). The incidence of trauma was high but not significantly different between groups (56.7% vs 40.9%; P ¼ .180). Clinical outcome measures and radiological outcomes in terms of retear were not statistically different between both groups (16.7% vs 8/5%; P ¼ .337). The optimal cutoff values for the risk of SSC tendon retear in both groups were 19-mm retraction and 16-mm superoinferior dimension (P ¼ .048). Unfavorable preoperative fatty degeneration of the SSC muscle (grades 3 and 4) was a significant risk factor for retear (odds ratio, 9.8; P < .001).Conclusion: Isolated SSC and combined AS RCTs were comparable except for patient age and sex; both had a high incidence of traumatic history. The current data suggest that the risk factors for retear after SSC repair in RCTs involving the SSC were tear size greater than 19 mm of retraction and unfavorable fatty degeneration (grade 3 or higher) of the SSC muscle.Recently, an increase has been noted in the number of studies focused on rotator cuff tears (RCTs) involving the subscapularis (SSC) muscle to enable a better understanding of the diagnosis, management, and outcomes. 35 The SSC is the largest rotator cuff tendon; it provides 50% of the rotator cuff force and plays an important role in shoulder stability and movements such as internal rotation, adduction, abduction, flexion, and extension. 13,20,25,43 Hence, restoring the function of the SSC muscle after a tear is crucial for normal shoulder function.The SSC muscle is reported to be involved in 78% of RCTs, most often in combination with other rotator cuff tendons. 40 The incidence of isolated SSC RCTs is reported to be 4%, 13 whereas combined RCTs involving the SSC and supraspinatus but without the infraspinatus (combined anterosuperior [AS]) are reported to accoun...

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Section: Discussionsupporting

confidence: 54%

mentioning

confidence: 99%

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Meshram

Rhee

Park

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Arthroscopic subscapularis repair has been estab-lished as a feasible option for the treatment of isolated subscapularis tears, which might obtain satisfactory functional and patientreported clinical outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

The Diagnostic Value of Subscapularis Clinical Tests in the Postoperative Diagnosis of Subscapularis Retears: An Ultrasound-Comparative Trial

Fandridis¹,

Malahias²,

Plagou³

et al. 2019

TOORTHJ

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Background: Different physical examination tests have been used to preoperatively determine both the presence and size of a primary subscapularis tear. On the contrary, no clinical trial has yet been published to assess the diagnostic validity of the aforementioned tests in diagnosing subscapularis retears after arthroscopic subscapularis repair. Objective: To investigate the diagnostic value of the most commonly used clinical tests in the diagnosis of subscapularis tendon retears after arthroscopic repair. Methods: A retrospective (prospectively collected data) case series involving 37 patients who were suffering from symptomatic complete subscapularis tendon tear was conducted. All patients underwent an all-arthroscopic subscapularis repair with the same operative technique. They were postoperatively evaluated (final end point of follow-up: 12 months) with the use of ultrasound, Constant-Murlay score (CS), bear hug test, internal rotation lag sign, Napoleon test and lift-off test. Sensitivity, specificity, accuracy, positive and negative prognostic values were calculated for each test. Results: Shoulder function was significantly improved according to the final CS. The internal rotation lag sign was the most sensitive for the diagnosis of postoperative subscapularis retears, while the Napoleon sign had the highest specificity. Although postoperative clinical tests yielded no false negative findings, they were poorly predictive as for new ruptures. Ten patients (27%), who were found with a positive (for re-rupture), postoperative, clinical test, had a sonographically intact subscapularis tendon repair. Conclusion: We strongly support the use of subscapularis-specific clinical tests as a composite, in combination with a specific interpretation of their results. If all tests are found negative for retear, then we could assume that the arthroscopic repair remains intact and no further diagnostic examination might be necessary. On the contrary, if at least one subscapularis-specific clinical test is positive for retear, then the patient will likely require additional imaging control for definite diagnosis.

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“…The studies of Gerber and Krushell [1] and Lo and Burkhart [2] were two giant leaps for understanding the clinical relevance of the subscapularis tendon repair which improves the outcomes after rotator cuff repair, and these are not the only ones providing data of improved outcomes following the surgical intervention for subscapularis tears. [3][4][5][6] The recognition of partial subscapularis tears may be challenging because of the difficulty to acquire an appropriate angle of view and obscuring intra-articular structures like an inflamed biceps tendon with scuffing. Neyton et al [7] suggested an arthroscopic technique to view the subscapularis insertion site.…”

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confidence: 99%

The forelock sign: A new arthroscopic finding in partial subscapularis tears

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Ataoğlu

et al. 2019

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada, subskapularis parsiyel yırtıklarının kakül işareti tanımlandı ve bu işaret ile hava yastığı işaretinin insidansları karşılaştırıldı. Hastalar ve yöntemler: Ocak 2013-Ocak 2016 tarihleri arasında omuz artroskopisi uygulanan hastalar arasından izole subskapularis yırtığı veya izole supraspinatus yırtığı tanısı konulan 120 hasta (39 erkek, 81 kadın; ort. yaş 51.3 yıl; dağılım, 25-79 yıl) subskapularis yırtığı (grup 1), tam kat supraspinatus yırtığı (grup 2), bursal yüz supraspinatus yırtığı (grup 3) ve eklem yüzü supraspinatus yırtığı (grup 4) grubu olmak üzere 30'ar hastalık dört gruba ayrıldı. Tüm hastaların ameliyatının video kaydı vardı. Biseps tendonunun uzun başı (BTUB)'nın bütünlüğü, subskapularis yırtığının Lafosse sınıflandırması ve kakül ve hava yastığı işaretlerinin insidansı değerlendirildi. Bulgular: Grup 1'de hava yastığı işaretinin insidansı %10, kakül işaretininki %60 idi. Kakül işareti grup 1'de diğer gruplardan (olasılık oranı %95 güven aralığında 10.46: 3.9-27.8) ve hava yastığı işaretinden anlamlı olarak daha sıktı (p<0.001). Biseps tendonunun uzun başı bu grupta çoğunlukla patolojikti ve bu da istatistiksel olarak anlamlıydı (p<0.01). Grup 1'de kakül işareti insidansı her BTUB patolojisinde ve Lafosse alt gruplarında benzerdi. Sonuç: Bu çalışmada tanımlanan kakül işareti parsiyel subskapularis tendonu yırtıklarında güçlü gözlemciler arası ve gözlemciler içi tutarlılıkla anlamlı olarak sık (%60) iken hava yastığı işareti nadirdi (%10). BTUB'nin bozuklukları subskapularis yırtıklarıyla güçlü bir şekilde ilişkiliydi fakat kakül işareti BTUB'nin durumunun veya Lafosse sınıflandırmasına göre parsiyel subskapularis tendon yırtığı tipinin bir göstergesi değildi. ABSTRACTObjectives: This study aims to identify the forelock sign of partial tears of the subscapularis and to compare the incidences of this sign and air bag sign. Patients and methods: One hundred and twenty patients (39 males, 81 females; mean age 51.3 years; range, 25 to 79) diagnosed as isolated subscapularis tear or isolated supraspinatus tear from among patients who underwent shoulder arthroscopy between January 2013 and January 2016 were divided into four groups of 30 patients each as the subscapularis tear (group 1), fullthickness supraspinatus tear (group 2), bursal-side supraspinatus tear (group 3), and articular-side supraspinatus tear (group 4) groups. All patients had video records of their operation. The integrity of the long head of biceps tendon (LHBT), Lafosse classification of the subscapularis tear, and the incidence of the forelock and air bag signs were evaluated. Results: The incidence of the air bag sign in group 1 was 10% and that of the forelock sign was 60%. The forelock sign was significantly more frequent in group 1 than in the other groups (odds ratio 10.46: 3.9-27.8 with 95% confidence interval) and the air bag sign (p<0.001). The LHBT was mostly pathologic in this group, which was also statistically significant (p<0.01). The incidence of the forelock sign in group 1 was similar in each LHBT ...

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Arthroscopic Repair of Isolated Subscapularis Tears: A Systematic Review of Technique-Specific Outcomes

Cited by 54 publications

References 30 publications

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

The Diagnostic Value of Subscapularis Clinical Tests in the Postoperative Diagnosis of Subscapularis Retears: An Ultrasound-Comparative Trial

The forelock sign: A new arthroscopic finding in partial subscapularis tears

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